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Plan Central Library - Archive 2016

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NEWS FOR ALL PROVIDERS

Date Posted Message
12/28/16 Four Chemotherapy Codes To Be Added To The List Of Procedures Requiring Authorization, Effective March 1, 2017
12/21/16 Highmark Reaches New Agreement With Myriad Genetic Laboratories For BRCA Testing
12/15/16 Highmark To Require Prior Authorization For Non-Emergent Ambulance Transport
12/09/16 Laboratory Management Program Changes Effective Jan. 1, 2017, And Feb. 6, 2017
11/23/16 Highmark's Medical Management & Policy Holiday Schedule
11/21/16 naviHealth Expansion Delayed For ACA Members
11/18/16 2016 UDC Program Latest Monthly Progress Reports Now Available
11/18/16 Pennsylvania Employees Benefit Trust Find (PEBTF): Benefit Changes For 2017
11/10/16 Radiology Management Urgent Auth Requests
11/07/16 Highmark's Retrospective Chart Retrieval Program Launching For ACA Members
11/04/16 Reduce Claims Adjustments And Denials: Obtain Auths Prior To Service
11/04/16 Launch Date Of Enhanced Clinical Editing Processes Extended To 11/7/16
11/01/16 Prior Authorization For Non-Emergent Ambulance Transport For Medicare Advantage Members, Effective Jan. 1, 2017
10/31/16 Formulary Clarification: Effective Jan. 1, 2017
10/26/16 Network Changes For Skilled Nursing Facilities
10/20/16 Annual Scorecards Now Available For PMMP Pathways Participants
10/20/16 Community Blue Network Will Support Walmart® Medical Benefits Program
10/19/16 Practice's With Multiple Locations: Complete The "Service Facility Location" Field
10/19/16 Include The Correct Original Claim Number On Electronic Requests For Adjustment
10/13/16 Highmark NaviNet System Downtime Scheduled For October 14-15
10/11/16 2016 UDC Program Bonus Multiplier Extended to End of Program
10/07/16 FluMist Quadrivalent Removed from List of Covered Vaccines
10/07/16 Attention Providers Who Service Members with Medicare and Medicaid Coverage
10/04/16 ffective 10/14/16: Clarification Of Prescription Drug Coverage For Select Convenience Kit Products
10/04/16 Reminder: Ensure Accurate Patient Information Is Reported
09/30/16 Radiology Management Program Updates Effective 10/3/2016
09/30/16 Attention Physical Medicine Providers: Error In Healthways Authorization Requests
09/30/16 Attention All Providers: Highmark Following Industry Standard For NDC Submissions
09/28/16 Flucelvax Influenza Immunization Coding Guidelines Explained
09/21/16 naviHealth Expansion To Include ACA Individual And Small Group Members
09/21/16 2016 UDC Program September Monthly Progress Reports Now Available
09/21/16 Correction Underway To Address Lab Claims Processing Error
09/16/16 New InterQual Collection Form: Available In Navinet After Sept. 15, 2016
09/08/16 Reminder: Your 1099 Tax Forms Are Available Electronically Via Our NaviNet System
09/07/16 Reminder: Secondary Diagnosis Codes Required For Medicare Advantage Ambulance Claims
09/01/16 Payments For UDC Program Q2 2016 Submissions To Be Released
09/01/16 National Drug Codes Required For All Bluecard Medicaid Claims
08/15/16 Effective 10/14/2016 Clarification Of Prescription Drug Coverage For Select Convenience Kit Products
08/09/16 Now Available: Laboratory Management Program Administrative Guide
08/09/16 Highmark Removing 30-Day Deadline For Outpatient Behavioral Health Authorizations
08/09/16 Reminder: Cover Sheets For UDC Forms Not Needed
08/09/16 Össur Free Running And Mobility Clinic To Be Held At Highmark Stadium Aug. 20
08/03/16 Final Compensation Report For Q4 2015 UDC Program Now Available
08/01/16 Upcoming Lab Management Program Web Orientation Sessions Aug. 17 And 19
07/27/16 Highmark NaviNet System Downtime Scheduled For July 29, 2016
07/12/16 Highmark Navinet System Downtime Scheduled For July 15-16
07/12/16 Attention Providers Licensing with American Well To Provide Virtual Visits
07/11/16 Laboratory Management Program Resources Now Available
07/08/16 Highmark Partnering with Healthways to Streamline Its Claim Logic
07/07/16 Update: New Metrics Added to The Provider Pathways Administrative Guide
06/28/16 Highmark To Launch Enhanced Clinical Editing Processes Starting 10/1/16
06/24/16 eviCore Lab Management Program Update: Prior Authorization Date Change
06/17/16 Authorization Requirements Removed From Certain 'C' Codes
06/17/16 Notify Highmark Of Banking Changes To Avoid EFT Payment Disruption
06/15/16 Attention All Providers: Avoid Claim Rejections On Injectable Drug Products
06/07/16 UPMC Mercy Out Of Network On July 1, 2016
06/06/16 Updates To eviCore Lab Management Program
06/03/16 Highmark And Quartet Partner For Better Overall Health
05/27/16 Medicare Advantage Chart Retrieval Program
05/27/16 Clinical Laboratory Fees Update June 1, 2016
05/26/16 Site of Service Expansion and Updated Co-Surgery Fee
05/26/16 Spinal Injection Codes To Be Deleted From The List Of Procedures Requiring Authorization, Effective 5/23/16
05/25/16 Changes To Question 2 In Healthways' Rapid Response System (RRS)
05/19/16 New Qualifying Metrics And Updated Semi-Annual Performance Reports For Physical Medicine Provider Pathways Program
05/02/16 Update: Enhanced Viewing In Navinet® Of Premium Delinquency Status For ACA Members
04/29/16 Highmark Implementing Lab Management Program July 1, 2016
04/29/16 Highmark Targets Health Care Fraud And Abuse
04/26/16 Cardiac Catheter Claims Incorrectly Rejecting
04/25/16 Reminder: Use Of Ultrasound In The Treatment Of Varicose Veins
04/18/16 Navinet EOBs, EOPs And Facility Remittances Will Be Delayed On Monday, April 18
04/18/16 Notify Highmark Of Banking Changes To Avoid EFT Payment Disruption
04/14/16 Highmark NaviNet System Downtime Scheduled for April 15
04/13/16 Servicing Blue Plan Medicaid Members
04/12/16 Important Note About Enhanced Viewing In Navinet® Of Premium Delinquency Status For ACA Members
04/11/16 Reminder: NDC Tiered Pricing Effective April 15
04/08/16 Highmark Addressing Incorrect Bluecard® P5173 Claims Rejection Error For Screening Or Preventive Services
04/04/16 NDC Policy Reminder HCPCS Codes Requiring NDC Submission
04/01/16 321 Codes To Be Deleted From The List of Procedures Requiring Authorization, Effective 04/1/16
03/31/16 Highmark Cancer Collaborative Launches in Pennsylvania
03/21/16 Highmark Staff Cannot Offer Coding Advice to Providers
03/17/16 Reminder: NaviNet is the Preferred Method of Obtaining Authorizations
03/08/16 Reimbursement News: All Network Providers Must Be Enrolled In EFT By March 31, 2016
03/04/16 Less HCPCS Codes Require NDC Submission
02/25/16 Highmark's Self-Service Tools: Easy & Efficient
02/25/16 Clarification On The Translation of the 270/271 Transactions
02/24/16 NaviNet Ref/Auth Inquiry Enhancements Coming
02/19/16 Implementation Delayed for NaviNet Ref/Auth Inquiry Enhancements
02/19/16 Medicaid Billing Requirements Beginning March 2016
02/18/16 Changes to Claim Adjustment Reason and Remark Codes on Electronic Remittances, Effective 2/12/16
02/12/16 Reminder: NDC Required on Claims Billed Under Medical Benefit
02/12/16 Highmark Urges Health Care Professionals to be Prepared to Detect and Treat Zika Virus Patients
02/09/16 New Effective Date For NaviNet Ref/Auth Inquiry Enhancements
02/05/16 Provider Manuals Now Include Highmark West Virginia
02/04/16 NDC Policy Changes
02/03/16 Seventeen Codes to be Added to List of Procedures Requiring Authorization, Effective 4/1/16
01/29/16 Navinet Ref/Auth Inquiry Enhancements Coming
01/29/16 Reimbursement News: All Network Providers Must Be Enrolled In EFT By March 31, 2016
01/29/16 Medicaid Programs Administered Through Blue Cross And Blue Shield Plans
01/29/16 New Quantity Level Limits For Opioids Effective Jan. 1, 2016
01/15/16 Several Skilled Nursing Facilities, Home Health Agencies No Longer In Network In 2016
01/15/16 Reminder: Use Online Research Tools Prior To Contacting Provider Service
01/11/16 Important Reminder: Continuity Of Care Agreement Reached By Highmark And UPMC Now In Effect

NEWS FOR PROFESSIONAL PROVIDERS

12/28/16 Four Chemotherapy Codes To Be Added To The List Of Procedures Requiring Authorization, Effective March 1, 2017
12/21/16 Highmark Reaches New Agreement With Myriad Genetic Laboratories For BRCA Testing
12/15/16 Initial Credentialing Request Form Temporarily Unavailable
12/15/16 Highmark To Require Prior Authorization For Non-Emergent Ambulance Transport
12/09/16 Laboratory Management Program Changes Effective Jan. 1, 2017, And Feb. 6, 2017
11/23/16 Highmark's Medical Management & Policy Holiday Schedule
11/21/16 naviHealth Expansion Delayed For ACA Members
11/18/16 2016 UDC Program Latest Monthly Progress Reports Now Available
11/18/16 Pennsylvania Employees Benefit Trust Find (PEBTF): Benefit Changes For 2017
11/10/16 Radiology Management Urgent Auth Requests
11/07/16 Highmark's Retrospective Chart Retrieval Program Launching For ACA Members
11/04/16 Reduce Claims Adjustments And Denials: Obtain Auths Prior To Service
11/04/16 Launch Date Of Enhanced Clinical Editing Processes Extended To 11/7/16
11/01/16 Prior Authorization For Non-Emergent Ambulance Transport For Medicare Advantage Members, Effective Jan. 1, 2017
10/31/16 Formulary Clarification: Effective Jan. 1, 2017
10/26/16 Network Changes For Skilled Nursing Facilities
10/20/16 Annual Scorecards Now Available For PMMP Pathways Participants
10/20/16 Community Blue Network Will Support Walmart® Medical Benefits Program
10/19/16 Practice's With Multiple Locations: Complete The "Service Facility Location" Field
10/19/16 Include The Correct Original Claim Number On Electronic Requests For Adjustment
10/13/16 Highmark NaviNet System Downtime Scheduled For October 14-15
10/11/16 2016 UDC Program Bonus Multiplier Extended to End of Program
10/07/16 FluMist Quadrivalent Removed from List of Covered Vaccines
10/07/16 Attention Providers Who Service Members with Medicare and Medicaid Coverage
10/04/16 ffective 10/14/16: Clarification Of Prescription Drug Coverage For Select Convenience Kit Products
10/04/16 Reminder: Ensure Accurate Patient Information Is Reported
09/30/16 Radiology Management Program Updates Effective 10/3/2016
09/30/16 Attention Physical Medicine Providers: Error In Healthways Authorization Requests
09/30/16 Attention All Providers: Highmark Following Industry Standard For NDC Submissions
09/28/16 Flucelvax Influenza Immunization Coding Guidelines Explained
09/21/16 naviHealth Expansion To Include ACA Individual And Small Group Members
09/21/16 2016 UDC Program September Monthly Progress Reports Now Available
09/21/16 Correction Underway To Address Lab Claims Processing Error
09/16/16 New InterQual Collection Form: Available In Navinet After Sept. 15, 2016
09/08/16 Reminder: Your 1099 Tax Forms Are Available Electronically Via Our NaviNet System
09/07/16 Reminder: Secondary Diagnosis Codes Required For Medicare Advantage Ambulance Claims
09/01/16 Payments For UDC Program Q2 2016 Submissions To Be Released
09/01/16 National Drug Codes Required For All Bluecard Medicaid Claims
08/15/16 Effective 10/14/2016 Clarification Of Prescription Drug Coverage For Select Convenience Kit Products
08/09/16 Now Available: Laboratory Management Program Administrative Guide
08/09/16 Highmark Removing 30-Day Deadline For Outpatient Behavioral Health Authorizations
08/09/16 Reminder: Cover Sheets For UDC Forms Not Needed
08/09/16 Össur Free Running And Mobility Clinic To Be Held At Highmark Stadium Aug. 20
08/03/16 Final Compensation Report For Q4 2015 UDC Program Now Available
08/01/16 Upcoming Lab Management Program Web Orientation Sessions Aug. 17 And 19
07/27/16 Highmark NaviNet System Downtime Scheduled For July 29, 2016
07/12/16 Highmark Navinet System Downtime Scheduled For July 15-16
07/12/16 Attention Providers Licensing with American Well To Provide Virtual Visits
07/11/16 Laboratory Management Program Resources Now Available
07/08/16 Highmark Partnering with Healthways to Streamline Its Claim Logic
07/07/16 Update: New Metrics Added to The Provider Pathways Administrative Guide
06/28/16 Highmark To Launch Enhanced Clinical Editing Processes Starting 10/1/16
06/24/16 eviCore Lab Management Program Update: Prior Authorization Date Change
06/17/16 Authorization Requirements Removed From Certain 'C' Codes
06/17/16 Notify Highmark Of Banking Changes To Avoid EFT Payment Disruption
06/15/16 Attention All Providers: Avoid Claim Rejections On Injectable Drug Products
06/07/16 UPMC Mercy Out Of Network On July 1, 2016
06/06/16 Updates To eviCore Lab Management Program
06/03/16 Highmark And Quartet Partner For Better Overall Health
05/27/16 Medicare Advantage Chart Retrieval Program
05/27/16 Clinical Laboratory Fees Update June 1, 2016
05/26/16 Site of Service Expansion and Updated Co-Surgery Fee
05/26/16 Spinal Injection Codes To Be Deleted From The List Of Procedures Requiring Authorization, Effective 5/23/16
05/25/16 Changes To Question 2 In Healthways' Rapid Response System (RRS)
05/19/16 New Qualifying Metrics And Updated Semi-Annual Performance Reports For Physical Medicine Provider Pathways Program
05/02/16 Update: Enhanced Viewing In Navinet® Of Premium Delinquency Status For ACA Members
04/29/16 Highmark Implementing Lab Management Program July 1, 2016
04/29/16 Highmark Targets Health Care Fraud And Abuse
04/26/16 Cardiac Catheter Claims Incorrectly Rejecting
04/25/16 Reminder: Use Of Ultrasound In The Treatment Of Varicose Veins
04/18/16 Navinet EOBs, EOPs And Facility Remittances Will Be Delayed On Monday, April 18
04/18/16 Notify Highmark Of Banking Changes To Avoid EFT Payment Disruption
04/14/16 Highmark NaviNet System Downtime Scheduled for April 15
04/13/16 Servicing Blue Plan Medicaid Members
04/12/16 Important Note About Enhanced Viewing In Navinet® Of Premium Delinquency Status For ACA Members
04/11/16 Reminder: NDC Tiered Pricing Effective April 15
04/08/16 Highmark Addressing Incorrect Bluecard® P5173 Claims Rejection Error For Screening Or Preventive Services
04/04/16 NDC Policy Reminder HCPCS Codes Requiring NDC Submission
04/01/16 321 Codes To Be Deleted From The List of Procedures Requiring Authorization, Effective 04/1/16
03/31/16 Highmark Cancer Collaborative Launches in Pennsylvania
03/21/16 Highmark Staff Cannot Offer Coding Advice to Providers
03/17/16 Reminder: NaviNet is the Preferred Method of Obtaining Authorizations
03/08/16 Reimbursement News: All Network Providers Must Be Enrolled In EFT By March 31, 2016
03/04/16 Less HCPCS Codes Require NDC Submission
02/25/16 Highmark's Self-Service Tools: Easy & Efficient
02/25/16 Clarification On The Translation of the 270/271 Transactions
02/24/16 NaviNet Ref/Auth Inquiry Enhancements Coming
02/19/16 Implementation Delayed for NaviNet Ref/Auth Inquiry Enhancements
02/19/16 Medicaid Billing Requirements Beginning March 2016
02/18/16 Changes to Claim Adjustment Reason and Remark Codes on Electronic Remittances, Effective 2/12/16
02/12/16 Reminder: NDC Required on Claims Billed Under Medical Benefit
02/12/16 Highmark Urges Health Care Professionals to be Prepared to Detect and Treat Zika Virus Patients
02/09/16 New Effective Date For NaviNet Ref/Auth Inquiry Enhancements
02/05/16 Provider Manuals Now Include Highmark West Virginia
02/04/16 NDC Policy Changes
02/03/16 Seventeen Codes to be Added to List of Procedures Requiring Authorization, Effective 4/1/16
01/29/16 Navinet Ref/Auth Inquiry Enhancements Coming
01/29/16 Reimbursement News: All Network Providers Must Be Enrolled In EFT By March 31, 2016
01/29/16 Medicaid Programs Administered Through Blue Cross And Blue Shield Plans
01/29/16 New Quantity Level Limits For Opioids Effective Jan. 1, 2016
01/15/16 Several Skilled Nursing Facilities, Home Health Agencies No Longer In Network In 2016
01/15/16 Reminder: Use Online Research Tools Prior To Contacting Provider Service
01/11/16 Important Reminder: Continuity Of Care Agreement Reached By Highmark And UPMC Now In Effect
12/27/16 Attn: Medicare Advantage Providers In Southwestern PA. - Introducing Blue Care Advantage VBID Pilot Program
12/12/16 Reduce Claim Denials: Report Surgery Code On All Anesthesia Claims
12/06/16 Quality Ratings Available In Find A Doctor
12/02/16 Providers To Receive E&M Coding Alerts From Change Healthcare's Coding Advisor Service
11/16/16 Transitioning Highmark Medicare Advantage Members To Select DME Network Providers In 2017
11/16/16 Highmark Select DME Network Frequently Asked Questions Revised
11/01/16 Colorectal Cancer Screening Kits Being Mailed To Select Highmark Members
10/31/16 Attn: Prescribing Physicians -- New Essential Formulary Effective Jan. 1, 2017
10/27/16 Avoid Claim Denials By Keeping Your Assignment Account Data Up-To-Date
10/14/16 Quality Rating Information On Find A Doctor Delayed
10/07/16 Reminder: Anesthesia Reimbursement Change Effective Oct. 15, 2016
10/05/16 Highmark In-Home Bone Mineral Density (BMD) Testing Program to End
10/03/16 Quality Rating Information On Find A Doctor Delayed
09/30/16 Reporting Emergency Services
09/20/16 COPD & Diabetes Survey - Please Respond By Sept. 28, 2016
09/20/16 Reminder: FEP Billing Guidelines For Immunization Administration
09/16/16 Attention Pharmacists: Administration Fee For Pharmacy-Based Vaccinations Readjusted To $10
09/14/16 Three Drugs Being Added To Highmark's Medical Injectable Drug Program
09/14/16 Walgreens Specialty Pharmacy Will Be Designated Provider For Certain HIT Drugs
09/06/16 Quality Rating Information Will Appear On Find A Doctor Oct. 1, 2016
09/01/16 Highmark Introduces The Select DME Network On Jan. 1, 2017
09/01/16 One Drug Being Removed From Highmark's Medical Injectable Drug Program
08/24/16 Attention Mental Health Professionals: Change Healthcare Coding Advisor Program To Review Psychotherapy Codes
08/15/16 Anesthesia Reimbursement Change Effective Oct. 15, 2016
08/12/16 Billing Requirements For Dental Anesthesia
07/27/16 Change Healthcare Coding Advisor Program To Assist Highmark In Improving Evaluation And Management Coding Practices
07/21/16 Reimbursement Policies to Debut on Provider Resource Center on Aug. 1, 2016
07/13/16 Attention Physicians Administering Xiaflex: Change To Highmark Medical Injectable Drug Program To Impact One Drug, Effective July 15, 2016
06/21/16 Attention Ordering Physicians: Myriad Genetic Laboratories Will No Longer Be In The Highmark Networks As Of Jan. 1, 2017
06/15/16 Effective 8/15/16, Administration Fees For Pharmacy-Based Vaccinations To Be Adjusted
06/06/16 Highmark Accepting New Members For Medical Review Committee
06/01/16 Highmark Schedules Payment Reductions For Services Reported With Modifier 54 or 55
06/01/16 Highmark To Reduce Allowances For Services Reported With Modifier 52 or 53
05/19/16 Highmark Plans Endoscopic Services Payment Reduction For Commercial Products
05/13/16 Twenty-One Drugs Being Removed From Highmark's Medical Injectable Drug Program
05/13/16 Changes To Highmark's Medical Injectable Drug Program To Impact 9 Drugs, Effective July 15, 2016
04/19/16 Update: Authorizations Required For Pain Management Injections, Effective 4/1/16
04/04/16 Highmark To Update Payment Differential On April 25, 2016
04/01/16 Reminder: Authorizations Required For Pain Management Injections, Effective 4/1/16
04/01/16 Radiology Fee Adjustments to be Delayed Until May 1, 2016
03/24/16 Highmark Accepting New Members For Medical Review Committee
03/18/16 Updated Locum Tenens Form Now Available
03/04/16 Register Today: 2016 UDC Program Training Webinars Begin March 28
02/29/16 2015 Unconfirmed Diagnosis Code (UDC) Program Q4 Additional Compensation Payments to be Delayed
02/17/16 Revised: Effective April 1, 2016, Highmark to Adjust Fees for KHPW and Premier Blue Shield ACA Individual Products
02/17/16 All Medicare Part D Drug Prescribers Must Be Enrolled In Medicare Or Opt Out By June 1, 2016
02/15/16 Effective April 1, 2016, Highmark to Adjust Fees for KHPW and Premier Blue Shield ACA Individual Products
02/01/16 Two Drugs Being Added As Voluntary For Highmark Medical Injectable Drug Program
02/04/16 Update: Changes To PEBTF Medical Benefit Specialty Medication Exclusion List
02/01/16 Adjustments To Radiology Services Reimbursement For UCR, Premier Blue Shield, KHPW: Effective April 4, 2016 May 1, 2016 (Updated 4/01/16)
01/29/16 Drug Becoming Voluntary For Highmark Medical Injectable Drug Program
01/28/16 2016 Medicare Advantage Incentive Program Teleconference Sessions
01/13/16 Annual HEDIS Medical Record Reviews To Begin In February
01/12/16 P4V Partners: True Performance Value-Based Reimbursement Sessions Set for Jan. 19-22
01/07/16 Professional Billing Guidelines for Multiple Same Day Services
01/07/16 Reminder: Certain Specialty Medications Excluded From Medical Benefit For PEBTF Patients
01/06/16 Two Weeks Remaining In The 2015 UDC Validation Program

NEWS FOR FACILITY PROVIDERS

12/16/16 Update Regarding Enhanced Inpatient Review And Discharge Planning
09/27/16 Reminder: Facilities Must File Outpatient Claims Using Correct Bill Type
08/31/16 Billing Lab Tests Without The L1 Modifier
08/30/16 Enhanced Inpatient Review And Discharge Planning
08/08/16 Attention Home Health Agencies: Home Health Authorization Process Technical Tips You Need To Know
08/05/16 Attention Home Health Agencies: Questions About The New Home Health Authorization Process?
07/11/16 Attention Home Health Agencies: Join Us July 18th For The New Home Health Care Authorization Request Submission Process Webinar
05/10/16 Change To Vaginal Delivery Claims
04/21/16 Reminder: Reporting Patient's Reason for Visit on ER Claims
04/01/16 Highmark Makes Annual Update To SNF Outpatient Fee Schedule For Medicare Advantage Members
03/01/16 Attention Skilled Nursing Facilities - Sign-up: Post-Acute Care Webinar
Last updated on 4/20/2021 1:55:17 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.