Plan Central Library - Archive 2015

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NEWS FOR ALL PROVIDERS

 

Date Posted Message
12/31/15 Documentation Requested For High Risk Medications
12/30/15 Colorectal Screenings For Commercial And Medicare Advantage Members
12/29/15 Updated Information On Pre-Service Organization Determinations For Medicare Advantage Members
12/28/15 New Quantity Level Limits For Opioids Effective Jan. 1, 2016
12/22/15 PCP & RETAIL Clinic Virtual Visit Fliers Available For Your Patients
12/18/15 Reminder: Network Providers Are Required By Contract To Notify Highmark Of Any Status Changes
12/17/15 Several Skilled Nursing Facilities, Home Health Agencies No Longer In Network In 2016
12/16/15 Several Skilled Nursing Facilities, Home Health Agencies No Longer In Network In 2016
12/10/15 Medicare Advantage: Ambulance Transport Services to Site of Medical Care Issue Identifed
12/10/15 NOC Codes Requiring Medical Review May Reject For Additional Information
12/08/15 Update Your Lactation Counseling Services Information Via Navinet®
12/07/15 Reminder: Care Registration Resets For The Physical Medicine Management Program Every Calendar Year
12/02/15 Highmark NaviNet System Downtime Scheduled for December 4-5
11/25/15 Medical Management and Policy Holiday Operating Hours
11/23/15 Be More Efficient: Take Advantage of Electronic Funds Transfer (EFT)
11/19/15 Highmark's Remaining 2015 And January 2016 Holidays
11/13/15 Reminder: National Drug Code (NDC) Requirement Begins Nov. 16, 2015
11/11/15 Annual Scorecards Available For Physical Medicine Provider Pathways Participants
11/10/15 Preventive Services Denial Now Corrected
11/05/15 Preventive Services Denial Identified And Currently Under Review
10/28/15 Obstetrical Ultrasound Criteria Revised; Correction To Obstetrical Ultrasound Article Published In September 2015 Medical Policy Update
10/27/15 3-D Mammograms Eligible
10/26/15 In 2016, Your 1099 Tax Form from Highmark Will Be Available Electronically Via Our NaviNet® System
10/21/15 List Of Procedure Codes Requiring NDC Information Available Now
10/21/15 Attention Private Duty Nursing Providers: Authorizations And Predeterminations For Private Duty Nursing Care
10/15/15 Epocrates Access to Highmark's Formulary Ending
10/13/15 Provider Service Telephone Lines: New Self-Service Prompts Being Rolled Out
10/09/15 PMMP Providers: Avoid Authorization Rejections
10/08/15 Chronic Care Management Code 99490 Not Separately Reimbursable
10/07/15 Highmark Navinet System Downtime Scheduled For Oct. 9-10
10/01/15 ICD-10: Auth Submissions Corrected: All Auth Submission Options Operational
10/01/15 ICD-10: Highmark Unable To Accept ICD-9 Auth Submissions - Date Of Service 9-30-2015 And Prior
09/30/15 ICD-10: Navinet Authorization Submissions Decimal Not Required: ICD-10-CM Codes
09/25/15 PMMP Providers: ICD-10 Update Regarding New Forms
09/25/15 Clinical Coding Testing Results To Date
09/24/15 UPDATE: The AIS Home Visit Program for Medicare Advantage Patients
09/21/15 ICD-10: Highmark Testing Endeavors: Testing Efforts Shared With Network Providers!
09/14/15 Keystone Health Plan West, Inc. To Get New Name: Highmark Choice Company
09/04/15 What's Up Wednesday ICD-10 Teleconference Scheduled For September 16, 2015
08/21/15 Highmark Retrospective Chart Retrieval Program Vendors Now Available
08/20/15 Some Self-Administered Oral Or Biotechnology Drugs To Be Available At Giant Eagle Specialty Pharmacy, Effective 1/1/2016
08/10/15 All Drug Claims Billed Under Medical Benefit Must Include NDC, Effective With Claims Submitted On Or After 11/16/15
08/10/15 Are You Prepared for ICD-10? Take the ICD-10 Readiness Survey Today!
08/07/15 "What's Up Wednesday" ICD-10 Teleconference Scheduled For August 19, 2015
08/04/15 Effective for Dates of Service on 10/09/2015, and beyond, NDC No Longer Reported For NOC Codes
07/24/15 Revisions to Commercial Medical Policies L-34 and S-230 Being Postponed
07/24/15 Clinical Views - Best Practice Source For Physicians And Clinical Staff - Issue 2, Now Available
07/21/15 PMMP Providers: Tips for Successful Auth Requests, Pathways Qualification
07/20/15 CMS ICD-10 Quick Start Guide Added To Tool Kit
07/20/15 Highmark Works To Curtail Health Care Fraud
07/16/15 Reminder: Change In Planned Test/Procedure Requires New Auth
07/10/15 Preventive Services: For Members Whose Recorded Gender Does Not Match The Gender For Certain Preventive Service
07/10/15 Clarification: Health Care Reform And Contraceptive Coverage
07/10/15 New Options Available: Provider Service Telephone Lines
07/08/15 Navinet Downtime July 10, 2015
07/01/15 Introducing The AIS Home Visit Palliative Care Program For Medicare Advantage Patients
07/01/15 “What's Up Wednesday” ICD-10 Teleconference Scheduled For July 15, 2015
06/30/15 Attention Qualifying Physical Medicine Provider Pathways Participants
06/30/15 New Connect Blue EPO Product Launching 7/1/15 In Select Counties; Learn More In This Special Edition Of Provider News
06/30/15 Dosing Limits For Stelara Enforced
06/26/15 Medicare Advantage Physicians And Specialists Employing CRNPs AND PAs
06/25/15 Vedolizumab (Entyvio®) Medical Policy Delayed Until Further Notice
06/19/15 Attention Navinet-Enabled Providers: Continue Stacking Services
06/17/15 Ensure Accurate Patient Information Is Reported
06/11/15 Introducing Connect Blue EPO: A Three-Tier Product In Certain Counties Starting July 1, 2015
06/09/15 Attention Physical Medicine Providers: Performance Reports Now Available Via Navinet
06/05/15 “What's Up Wednesday” ICD-10 Teleconference Scheduled For June 17, 2015
06/02/15 Highmark Inc., BCNEPA Merger Gets Approval From Pennsylvania Insurance Department
05/29/15 Use Electronic Provider Access Portal For Bluecard Authorization Request
05/28/15 Correction to Effective Date for Medical Policy Bulletin Z-13, Emergency Medical Care Changes: Hmk Z-13 Will Be Effective July 27, 2015
05/14/15 Notice Regarding Healthways Systems Issue
05/11/15 Attention Physicians Who Perform MOHS Surgery: Correction Underway To Address Mohs Claims Processing Issue
05/06/15 Register Now for the Quality Blue P4V Regional Care Delivery Model Forum on May 27
05/06/15 Predeterminations Recommended for Private Duty Nursing
05/04/15 Updated Physical Medicine Management Program Administrative Guide is Now Available Online
04/24/15 Highmark Navinet System To Be Offline Overnight April 25 To 26
04/22/15 Physical Medicine Provider Pathways - FAQs
04/22/15 Attention Air Ambulance Service Providers: Air Ambulance Claims Filing Rules, Requirement To Report Point Of Pickup
04/17/15 Effective 6/1/15, You Must Use Navinet To Add/Remove Practitioners On File With Highmark
04/16/15 Navinet Authorization Transaction Enhancements Coming Soon
04/16/15 Highmark Navinet System Downtime Scheduled For April 17-18
04/15/15 New Tool Kit May Offer Assistance With ICD-10 Transition
04/03/15 'What's Up Wednesday' ICD-10 Teleconference Scheduled For April 15, 2015
03/25/15 Radiology Site Selection Pilot Program Delayed
03/20/15 To Launch 3/23/15, Pilot Program Will Educate Selected Members About Lower-Cost Imaging Providers
03/18/15 Highmark Navinet System Downtime Scheduled For March 20-21
03/18/15 Lemtrada Coding Tip
03/10/15 Provider Resource Center HIPAA Link Updated To: ICD-10/HIPAA
03/06/15 'What's Up Wednesday' ICD-10 Teleconference Scheduled For March 18, 2015
02/23/15 A Clarification In Healthways Rapid Response System
02/19/15 Important Changes Effective 4/20/15: Provider Assignment of Liability
02/10/15 Clinical Laboratory Fees
02/09/15 New Freedom Blue PPO NAIC Code May Require Additional Action From Clearinghouses
02/08/15 Highmark's Statement On Anthem Security Breach
02/08/15 'What's Up Wednesday' ICD-10 Teleconference Scheduled For February 18, 2015
02/04/15 Highmark Retains 5.3 Million Members For 2015
02/02/15 Highmark Navinet System Downtime Scheduled For February 6-7
01/27/15 Clarification Regarding NaviNet Auth Submission Process For Xgeva, Prolia
01/26/15 Correction: Use P.O. BOX 890062 For Freedom Blue PPO Paper Claims
01/26/15 Medical Policy Update Now Online – Read This Issue Today!
01/23/15 CMS Update On Pre-Service Organization Determinations For Medicare Advantage Members
01/14/15 Reminder: Use New NAIC Number For Claims For Freedom Blue PPO, Effective Jan. 1, 2015
01/09/15 'What's Up Wednesday' ICD-10 Teleconference Scheduled For January 21, 2015
01/08/15 Reminder: Change in Freedom Blue PPO Structure, New NAIC Number Coming

NEWS FOR PROFESSIONAL PROVIDERS

Date Posted Message
12/30/15 Update The Provider Directory With Your TruHearing Status
12/22/15 Utilize New Highmark Reports To Correct Errant Diagnoses From Quality Information
12/21/15 13 Drugs Being Added To Self-Administered Injectable Or Oral Biotechnology Drugs Program, Effective 1-15-2016
12/17/15 Highmark ACA Retrospective Chart Retrieval Program to Launch
12/14/15 Important Update: 5 Drugs Being Added As Voluntary For Highmark Medical Injectable Drug Program, Effective 2/15/16
12/08/15 Attention PCPs: Important UDC Program News
12/07/15 Certain Specialty Medications Excluded From Medical Benefit For PEBTF Patients, Effective 2/1/16
12/01/15 Reminder: Clinical Restrictions For Several Drugs, Effective 1/30/16
11/24/15 Unconfirmed Diagnosis Code (UDC) And Enhanced AWV (EAWV) Program Payments To Be Released By Dec. 7, 2015
11/18/15 Unconfirmed Diagnosis Code (UDC) Program Progress Reports Issue Identified On Two Tabs
11/17/15 Seven Drugs Being Added To Medical Injectable Drug Program, Effective Jan. 15, 2016
11/16/15 Update The Provider Directory With Your TruHearing Status
11/11/15 Unconfirmed Diagnosis Code (UDC) Program Progress Reports Now Available
11/11/15 Supporting Health Care Transparency With Physician Quality Measures (PQM)
11/02/15 Reminder For Prescribers: Several Drugs Will Have New Prior Authorization Clinical Restriction, Effective Dec. 1, 2015
11/02/15 Attention PCPs: Select Medicare Advantage Members To Receive Free Colorectal Cancer Screening Kits
10/29/15 DMEPOS Providers and Physicians: Highmark to Change Pulse Oximeter Rental Fee, Effective 1/1/16
10/21/15 Tips For Submitting Authorization Requests For Eylea, Macugen, Lucentis
10/15/15 4 Drugs Being Added As or Becoming Voluntary for Highmark Medical Injectable Drug Program, Effective 12/15/15
10/14/15 FYI for Ordering Physicians: Two Independent Clinical Laboratories Will No Longer Be in Highmark's Networks As of 1/1/16
10/13/15 Attention Oncologists: Rituxan Now Voluntary For Medical Injectable Drug Program
10/07/15 ICD-10: Mass Claim Adjustment Forms Updated
10/05/15 Medicare Enrollment Or Valid Opt-Out Required For Part D Prescription Coverage: Deadline Extended
09/29/15 Highmark's Prevention Campaign
09/22/15 Unconfirmed Diagnosis Code (UDC) Program Information Related to ICD-10 Compliance
09/15/15 Providers Requesting Authorization For Non-Highmark Members Via Fax
09/14/15 Understanding When To Use New Patient Versus Established Patient Evaluation And Management Codes
09/11/15 Attention Oral Surgeons: Good News! You Can Now Submit Electronic Oral Surgery Claims Directly To Highmark
09/10/15 Highmark's Partnership With Truhearing Enhances Medicare Advantage Benefit
08/21/15 Unconfirmed Diagnosis Code Program Update
08/17/15 Initiating Authorization Requests For Certain Drugs: Eylea, Macugen, Lucentis
08/10/15 Streamlined Access To Network Fee Schedules On The Provider Resource Center
08/07/15 Attention PCPs and Pediatricians: Watch Your Mail for Commercial ACA Member Unconfirmed Diagnosis Code Reports, Q&A Training Sessions Added
08/05/15 Routine Chlamydia Screening: Encourage Your Patients To Get Tested
08/03/15 Attn: Physicians Who Prescribe Inhaled Antibiotics Used for Cystic Fibrosis
07/24/15 Unconfirmed Diagnosis Code Validation Program Launched July 20
07/24/15 Earn Free CMEs: Online Clinical Documentation Improvement Series Workshops Begin in August
06/09/15 Medicare Advantage Physicians And Specialists Employing CRNPs AND PAs
05/27/15 Great News – Navinet Enhancements Make Drug Authorization Process Faster Than Ever!
05/20/15 Provide Infusion Drug Administration & Setting Details On Medicare Advantage Coverage Requests
05/20/15 Prolia May Be Covered Under Medicare Part B In Certain Circumstances
05/19/15 Effective July 14, 2015, New Quantity Level Limits For Certain Prescription Drugs
05/12/15 Please Complete National Behavioral Health Accessibility Questionnaire
05/08/15 Attention Physicians Who Perform MOHS Surgery: Correction Underway To Address Mohs Claims Processing Issue
04/15/15 National Healthcare Decisions Day Puts Focus On Advance Care Planning
04/01/15 Highmark To Require Prior Authorization For Concurrent Use Of These Drug Types
04/01/15 Coverage of Numerous Topical Patches/Gels to be Discontinued for Commercial Members
03/20/15 Notice Regarding Drug-Specific Surveys For Prescriptions That Require Authorizations
03/18/15 Reminder: Highmark To Update Payment Differential On 4/13/15
03/11/15 Part D Drug Prescribers Must Enroll In Medicare Or Have Valid Opt-Out By June 1, 2015
03/09/15 Highmark Now Reimburses For New CPT Codes For Advance Care Planning
03/04/15 Changes To Self-Administered Injectable Or Oral Biotechnology Drugs Program
03/04/15 13 Drugs Being Added To Highmark’S Medical Injectable Drug Program, Effective 5/4/15
03/04/15 Walgreens Specialty Pharmacy Will Be Designated Provider For Certain Hit Drugs
03/03/15 Highmark Passport Encourages Use of Annual Wellness Visit, Other Health Options
02/27/15 Attention Prescribing Physicians: Important News About Cymbalta
02/24/15 We're Making The Drug Authorization Process Faster Than Ever With Navinet!
02/12/15 New Reminder Message On Submission Form Helps Avoid Unnecessary Auth Requests For At-Home Sleep Studies
02/11/15 New Office Orientation Webinar Wednesday, February 18, 2015
02/03/15 Claims Denials For Code 99213 Could Be Inaccurate – Impacted Claims Submitted On 12/19/14
01/14/15 Attention PCP Practices: Join Us For 2 Webinars About Highmark’s 2015 Medicare Advantage Incentive Program
01/14/15 Annual HEDIS Medical Record Reviews To Begin In February
01/13/15 An Opportunity To Become Part Of A Practice Transformation Network
01/12/15 Attention Cardiologists: Highmark Now Accepting Candidates For Pharmacy And Therapeutics Subcommittee
01/12/15 Attention EMS Providers: Visit Highmark 2015 Page For FAQs Regarding Consent Decree
01/09/15 2015 Medicare Physician, Anesthesia Fees Not Yet Showing In Highmark's Navinet® Allowance Inquiry

NEWS FOR FACILITY PROVIDERS

Date Posted Message
12/10/15 Maternity Clarification: Vaginal Delivery Claims Submissions
12/03/15 Starting 1/1/16, PO Modifier Required On All Claims For Services Furnished At Off-Campus Provider-Based Departments
09/25/15 ICD-10: ER and Observation Services, Spanning Compliance Date, Clarified
08/31/15 Attention Hospitals With Swing Bed Units: Swing Bed Utilization Management Transitioning To NaviHealth Oct. 1, 2015
08/10/15 Streamlined Access To Network Fee Schedules On The Provider Resource Center
07/30/15 Non-Discrimination Reminder For Participating Skilled Nursing Facilities
06/03/15 Eight Injectable Drugs To Require Authorization, Beginning In June/July 2015
04/06/15 Eight Injectable Drugs to Require Authorization, Beginning in June 2015
03/12/15 Incorrect Payments Identified Impacting Some Claims Reimbursed At RUG Rates Methodology
03/10/15 Reporting ADL Level Identified on MDS Admission Assessment
02/27/15 Highmark Makes Annual Update To Skilled Nursing Facility Outpatient Fee Schedule For Medicare Advantage Members
02/11/15 Important Notice: Urgent Inpatient Requests via Authorization Submission Transaction Reviewer Comments Not Available for Some Facilities
02/02/15 Post-Acute Care Management For Medicare Advantage Members Page Has Been Updated: Administrative Guide Now Available
01/30/15 Robotic Surgical System Not Eligible For Reimbursement, Claims To Be Audited
01/29/15 Updated Medicare Advantage Forms Now Available On The Provider Resource Center (PRC)
01/26/15 Clarification: Send WPEE-Highmark Member Inpatient/Outpatient Claims To Clearinghouse
01/23/15 Mandatory Prior Authorization For Eight Chemotherapy Drugs Begins March 30, 2015
01/15/15 Important Information Regarding WPEE Member Benefits And Claims
01/14/15 Register Now for Educational Session with naviHealth: The Science Behind the Tool

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Last updated on 10/17/2017

 

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