Credentialing - New York Providers

New Policy Coming

There will be a new policy for new providers credentialing with Highmark Blue Cross Blue Shield of Western New York and providers who are recredentialing with Highmark BCBSWNY. The new policy effective date is August 1, 2022.

Read Chapter 3 of the Highmark Provider Manual on Provider Network Participation for complete policy details.

• Highmark Provider Manual Chapter 3 - Provider Network Participation

The links below outline the differences between the previous credentialing policy and the new policy that goes into effect on August 1, 2022.

• Changes to Credentialing Policy for Professional Providers
• Changes to Credentialing Policy for Facility/Organizational Providers

Initial Credentialing

Providers can enroll in our health plan by completing the Universal Credentialing Application with CAQH, the Council for Affordable Quality Health Care.

• UPD Quick Reference Guide

How it Works:

Follow this link to access the Universal Provider DataSource

• Under Providers, click 'Go to the Universal Provider Datasource' and login.
• Enter your CAQH Provider ID (if you don't know it, call CAQH at 1-888-599-1771).
• Enter or update your information.
• Authorize Highmark BCBSWNY to access your information electronically.

Complete the form below and return to the fax number provided.

• New Provider Enrollment & Disclosure of Ownership Control
• Provider Enrollment Application Checklist

Dental Providers – IMPORTANT

Dental Providers who intend to bill for both medical and dental services for Highmark Blue Cross Blue Shield of Western New York members will need to follow a new process to be credentialed and contracted.

• Dental providers seeking credentialing for medical services should complete the New Provider Enrollment & Disclosure of Ownership Control form.
• Dental providers seeking credentialing for dental services only should enroll with United Concordia Dental.

Recredentialing

Professional Providers

Providers who are currently credentialed with Highmark Blue Cross Blue Shield of Western New York will not need to recredential until you are normally due to recredential with us. You will need to continue doing this through the usual CAQH process. Once you have attested/updated your information in CAQH, there is nothing else you need to do.

You can always reference the Highmark Affiliation FAQs for more information.

Facility and Ancillary Providers

HMNY Recredentialing Application for Facility and Ancillary Providers

• Facility and Ancillary Providers who have recently received a Facility and Ancillary Recredentialing Announcement letter should use this application to begin the recredentialing process.