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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.

  • Provider Credentialing and Recredentialing Process Changes

    January 27, 2022

    In the next few months, we will be implementing some changes for provider credentialing and recredentialing. These changes will apply to providers and facilities with a medical agreement. As a reminder, network practitioners must be recredentialed every three years. In this article, you can learn more about these upcoming changes, and how they apply to individual practitioners as well as facility and ancillary providers .
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  • Annual HEDIS Campaign

    January 27, 2022

    Our annual HEDIS Medical Record Review begins in February. As we do every year, we will be requesting medical records to support the care you provide to your Highmark Blue Shield of Northeastern New York patients. Here, you can learn how to submit your records and view the measures used to conduct this campaign.
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  • Updated Drug Therapy Guidelines Available Online - January 2022

    January 27, 2022

    Drug Therapy Guidelines were recently updated for your patients on both the Highmark and legacy systems. Sixty-five drug therapy guidelines for patients on the legacy systems were recently added or updated with a committee of local physicians, other prescribers, and pharmacists. Changes to existing Drug Therapy Guidelines as well as coverage for newly FDA-approved medications will be posted on our website by February 7 and will be effective March 7. Highmark’s recently reviewed and approved drug policy guidelines are now available through the Provider Resource Center.
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  • Medical Record Retrievals

    January 27, 2022

    We do our best to minimize the disruption of medical record requests to your practice as we work to meet continued documentation requirements. Whenever possible, we streamline our outreach to help manage multiple requests. In this article, you can find guidance for handling medical record requests from other Blue plans and submitting records to our vendor Inovalon.
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  • Proper Coding for Anesthesia Claims

    January 27, 2022

    Proper coding ensures correct claims-processing and helps you get paid correctly. Anesthesiologists and certified registered nurse anesthetists (CRNA) submitting electronic claims for patients on both Highmark and legacy systems must include the appropriate taxonomy code. Here, you can find billing guidance for anesthesia services.
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  • Highmark Medical Policy Updates Available Online – January 2022

    January 27, 2022

    Highmark’s monthly Medical Policy Update Newsletter will be available online on or before January 31. These changes may impact your patients who have moved onto Highmark’s system.
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  • New Enumeration Form for Advanced Practice Providers (APPs) Now Live

    January 14, 2022

    We previously announced a new enumeration process for Advanced Practice Providers (APPs) beginning January 1, 2022. As a reminder, APPs will no longer be required to be fully credentialed with us. To enumerate, APPs will need to complete a simple online form within Highmark’s systems.
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  • Preauthorization Temporarily Waived for In-Network Hospital and Facility Transfers

    January 14, 2022

    In accordance with the recent DFS Circular Letter 1 (2022), we are temporarily removing preauthorization review of all patient transfers between in-network hospitals and in-network rehabilitation and skilled nursing facilities following an inpatient stay. This temporary change will be effective for 30 days as of January 6, 2022 for your Highmark Blue Shield of Northeastern New York commercial, Medicare Advantage and self-insured ASO patients*.
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  • 2022 Medication Coverage Changes

    December 21, 2021

    Beginning January 1, some previously prescribed medications for your Highmark Blue Shield of Northeastern New York (Highmark BSNENY) Commercial and Medicare Advantage patients may have different cost-share, quantity limitations, coverage criteria, or may not be covered. In this article, you can find a list of top impacted medications.
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  • $2.67 Million Awarded to Address Racial and Health Inequities

    December 21, 2021

    Highmark of Western and Northeastern New York has announced a $2.76 million investment focused on addressing racial and health inequities in its local communities. This brings our total 2021 community investments and partnerships to more than $7 million as part of a commitment to invest $70 million over the next decade. Major grant recipients include the Whitney M. Young Jr. Health Center. Here, you can read more about these initiatives.
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