Information on this Provider Resource Center site is for members who have moved onto Highmark's systems.
For information related to members who have not moved onto Highmark's systems, please visit bcbswny.com/provider.

Authorization Requirements

Highmark Blue Cross Blue Shield of Western New York (Highmark BCBSWNY) requires authorization of certain services, procedures, and/or DMEPOS prior to performing the procedure or service. The authorization is typically obtained by the ordering provider. Some authorization requirements vary by member contract. This site is intended to serve as a reference summary that outlines where information about Highmark BCBSWNY's authorization requirements can be found. (This information should not be relied on as authorization for health care services and is not a guarantee of payment.)

Checking Authorization Requirements
To check a member's authorization requirements, call the precertification number on the back of their card. Additionally, in-network providers can utilize NaviNet® to check eligibility and benefits for Highmark BCBSWNY members; out-of-area providers can check for the member's benefits through BlueExchange via their local portal.®

If you must submit a request by phone, call the appropriate number below to reach Medical Management & Policy:

Medical: 1-844-946-6263
Behavioral Health: 1-844-946-6264

View the List of Procedures/DME Requiring Authorization*

*This is not an all-inclusive list. Benefits can vary; always confirm member coverage.

View the List of FEP Standard and Basic Procedures/DME Requiring Prior Approval
View the List of FEP Blue Focus Procedures/DME Requiring Prior Approval

The ordering provider is typically responsible for obtaining authorizations for the procedures/services included on the List of Procedures/DME Requiring Authorization. The procedure codes contained on the list requiring authorization and related effective dates are subject to change. Highmark will provide written notice when codes are added to the list; deletions are announced via online publication.

Note: Highmark Blue Cross Blue Shield of Western New York has partnered with eviCore healthcare (eviCore) for the Advanced Imaging and Cardiology Services Program. Additional information about the program and links to prior authorization codes are available under Care Management Programs in the left website menu.

For more information on Authorizations, please reference Chapter 5, Unit 2 of the Highmark Provider Manual.

Last updated on 1/3/2022 4:02:12 PM

 

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