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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 4/20/2021 1:55:05 PM

 

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Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration.