PLEASE NOTE: This page is for archival reference as our newsfeed has moved. For the latest news and updates, CLICK HERE to visit Provider News.
Blue Bulletin
Highmark Blue Shield of Northeastern New York strives to provide our network of provider practices and facilities with the most current health plan information in a quick and easily accessible manner.
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Introducing Highmark’s Provider News
December 20, 2022
As part of our affiliation with Highmark, we want to create a more seamless and enhanced provider experience. To support this, we will transition our monthly provider communication from “Blue Bulletin” to “Provider News.” Beginning in January, you’ll receive Highmark’s monthly Provider News emails at the end of each month replacing Blue Bulletin. Provider News will deliver local information to help you work with us, including reimbursement, coding, preauthorization, and policy updates. In this article, you can find more information and view the Provider News webpage on the Highmark Provider Resource Center (PRC).
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Reminder: Highmark Commercial and Medicare Advantage Reimbursement Policies
December 20, 2022
As a reminder, on January 1 after all your Highmark Blue Shield of Northeastern New York patients are on Highmark’s systems, we will be following Highmark’s reimbursement policies for commercial and Medicare Advantage lines of business. Here, you can find out how to access Reimbursement Policies on the Highmark Provider Resource Center (PRC).
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Population Health University - Clinical Pharmacy Resources Available Online
December 20, 2022
Before discussing, prescribing, and deprescribing certain medications with your Highmark Blue Shield of Northeastern New York patients, Highmark’s Population Health University offers clinical pharmacy resources to assist you. In this article, you can learn how to access the toolkits that provide useful pharmacy guidance.
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Provider Tools and Resources Remaining on the Legacy Website
December 20, 2022
Our legacy provider website will be decommissioned on February 1, 2023, at which point you will be redirected to the Highmark Provider Resource Center (PRC). Despite this change, you will still be able to access several tools and pages on the legacy website. Here, you can find out which content will be remaining and where to find it.
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Credentialing and Enumeration for Nurse Practitioners and Certified Registered Nurse Anesthetists
December 20, 2022
Beginning January 1, nurse practitioners will have the option to be fully credentialed as a primary care provider (PCP), specialist, or enumerated in either role. Certified registered nurse anesthetists will have to option to credential as a specialist or be enumerated in the reimbursement system only. In this article, you can find information on how to credential and enumerate.
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Highmark Medical Policy Updates Available Online – December 2022
December 20, 2022
We recently reviewed 40 medical protocols. These policies will be posted online on or before January 1, 2023 and will apply for dates of service prior to January 1. Highmark’s monthly Medical Policy Update Newsletter will be available online on or before December 22.
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2023 Cardiac Prior Authorization Changes
December 20, 2022
Throughout the year, Highmark makes several adjustments to its full list of outpatient procedures, services, durable medical equipment, and drugs requiring prior authorization. In this article, you can view the changes that should be expected in 2023.
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2023 Medicare Advantage Drug Formulary and Pharmacy Prior Authorization Changes
November 29, 2022
Beginning January 1, 2023, some of your Highmark Blue Shield of Northeastern New York (Highmark BSNENY) Medicare Advantage patients may be affected by changes to Highmark’s pharmacy drug formulary. In early December, please be on the lookout for letters detailing select formulary changes affecting your Medicare Advantage patients. Medication-related prior authorization requests will be submitted to and reviewed by our Utilization Management (UM) team. In this article, you can review 2023 formulary updates along with information about the Medicare Advantage pharmacy prior authorization review process as all Medicare Advantage members move onto Highmark’s system.
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Enhancements to NaviNet Prior Authorization Experience
November 29, 2022
We will begin rolling out enhancements to our utilization management (UM) tool through NaviNet on January 1, 2023. These enhancements are intended to streamline your experience by enabling faster reviews and greater transparency around the status of your authorization requests. Here, you can find tips for submitting NaviNet authorization requests on the new platform.
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Prior Authorization Changes Postponed for Musculoskeletal Procedures and Pain Management, Molecular and Genomic Testing, and Radiation Oncology
November 29, 2022
We are postponing the authorization requirement changes for some musculoskeletal (MSK) procedures and interventional pain management, molecular and genomic testing, and radiation oncology services that we announced last month. The requirement updates, which will be managed by eviCore, will not take effect until late Q1 or early Q2. Webinars will be scheduled to orient providers to the eviCore programs before they take effect.
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