Skip to main content

Working With Us

Click on the articles below for more educational information and updates to our policies. 

  • Managed Care for Members with Special Needs Including Medicare Advantage Dual-Eligibles

    The following drug therapy guidelines have been updated. Please refer to these updated guidelines when discussing treatment options with your BlueCross BlueShield of Western New York patients.
    Continue Reading
  • Opting Out of Medicare

    Federal regulations prohibit Medicare Advantage (MA) organizations, including BlueCross BlueShield of Western New York, from paying for services rendered by physicians or practitioners who have chosen to opt out of the Medicare program, except in limited circumstances.
    Continue Reading
  • Out-of-Plan Referral Guidelines

    Out-of-plan (OOP) referrals should be requested for BlueCross BlueShield of Western New York patients only when the patient is outside his or her service area and participating providers in the area cannot provide the necessary services.
    Continue Reading
  • Perceived Denials

    We appreciate and support your efforts to manage your BlueCross BlueShield of Western New York Medicare Advantage patients’ care in a prudent, cost-effective manner. The Centers for Medicare & Medicaid Services (CMS) requires that members who perceive denial of treatment or care are entitled to certain appeal rights under federal law.
    Continue Reading
  • Updating Your Provider Information

    Provider data elements are required by CMS and crucial for member access. Health plans should also be included in up-to-date information about your practice. Read more about updating your provider information
    Continue Reading

Working with Us

Additional Resources

We want to hear from you! Have a topic request for the next Blue Bulletin? Email us

Stay in Touch! Sign up to receive emails for provider news and information