Plan Central Library - 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 10/17/2017

 

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