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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.

  • Reminder: Proper Billing for Behavioral Health Providers

    July 25, 2022

    As a reminder, behavioral health providers must include the correct taxonomy and performing provider information (when applicable) on 837P and CMS 1500 claims for Legacy and Highmark system patients. Doing so ensures your claims are processed correctly.
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  • LabCorp Update for Highmark Patients

    July 20, 2022

    We are aware of a recent document distributed by LabCorp indicating that they are a participating lab for Highmark patients in Upstate New York. Please note: LabCorp is considered out-of-network for ALL Highmark patients regardless of where their plan is based (this includes Delaware, Pennsylvania, New York, and West Virginia).
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  • Dental and Oral Surgery Claims to be Processed by United Concordia Dental (UCD)

    June 30, 2022

    Dental and oral surgery claims for your Highmark Blue Shield of Northeastern New York patients who are on Highmark’s system, need to be sent directly to United Concordia Dental (UCD). This includes any oral surgery claim that uses a code beginning with “D.”
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  • Introducing Kayvin Robertson, Vice President, Provider Contracting and Relations

    June 28, 2022

    We are excited to introduce our newly appointed Vice President, Provider Contracting and Relations at Highmark Blue Shield of Northeastern New York, Kayvin Robertson. Robertson will be working with our network providers and managing provider agreements. In addition, he’ll develop innovative provider reimbursement programs that will allow our providers to deliver the best health care to their patients. In this article, you can learn more about Robertson, including his background and vision for provider partnerships in the Capital Region.
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  • Diabetes Patients Moving to Well360 Diabetes Management July 1

    June 28, 2022

    Beginning July 1, your Highmark Blue Shield of Northeastern New York patients with Type 2 diabetes (ages 18 and older) will be offered Well 360 Diabetes Management powered by Onduo, a new virtual care program to help them manage their diabetes between office visits. In addition, your patients who were previously using Livongo to manage their diabetes will start transitioning to Well360 Diabetes Management. Here, you can learn more about this new program and find out how to refer your eligible patients.
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  • MCG Chosen as UM Clinical Criteria Vendor

    June 28, 2022

    Milliman Care Guidelines (MCG) has been chosen as our acceptable use criteria vendor to review utilization management (UM) requests beginning February 1, 2023. Our transition from Change Healthcare (InterQual) to MCG will more fully support our Living Health strategy and allow us to upgrade our UM capabilities and automation. These new capabilities will allow us to provide more visibility to UM criteria at the point of care, better support interoperability, and reduce administrative burden for providers.
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  • Preauthorization Codes Added to List for Patients on Highmark's System

    June 28, 2022

    Seventeen (17) Transplant CPT codes will be added to the List of Procedures/DME Requiring Authorization on July 1, 2022. These codes apply only to your Highmark Blue Shield of Northeastern New York patients who have transitioned onto Highmark’s system.
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  • Updated Drug Therapy Guidelines Available Online - June 2022

    June 28, 2022

    Drug Therapy Guidelines were recently updated for your patients on both the Highmark and legacy systems. Twenty-nine (29) drug therapy guidelines were added or updated recently by a committee that includes local physicians, other prescribers, and pharmacists. Highmark’s recently reviewed and approved drug policy guidelines are now available through the Highmark Provider Resource Center.
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  • Medical Protocol Updates Available Online – June 2022

    June 28, 2022

    We recently reviewed 66 medical protocols. These protocols will be posted online on or before July 1, 2022, and will have an effective date of August 1, 2022, unless otherwise noted. Highmark’s monthly Medical Policy Update Newsletter will be available online on or before June 27, 2022.
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  • Patients Moving onto Highmark’s System July 1

    May 26, 2022

    As of July 1, more than 50% of patients covered by Highmark Blue Shield of Northeastern New York (Highmark BSNENY) will be on Highmark’s system. NaviNet is an essential resource for checking these patients’ benefits and eligibility, submitting preauthorization requests, viewing explanation of benefits (EOBs), and submitting claims. In addition, we want to remind you of several tools and resources you can use to view patient updates. In this article, you can find these resources and register for NaviNet if you have not already done so.
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