Provider Orientation

WELCOME TO HIGHMARK BLUE CROSS BLUE SHIELD OF WESTERN NEW YORK!

If you are a newly contracted provider, or a new employee of a network provider's office or facility, we would like to introduce you to the many resources we make available to help you in your interactions with Highmark Blue Cross Blue Shield of Western New York (Highmark BCBSWNY) and our members. 

Let's begin with some background on Highmark to help you get to know us:

• History of Highmark
• Highmark's Mission, Vision, and Values

And now to get started working with Highmark BCBSWNY, here is what you need to know: 

• All network providers are required to be NaviNet-enabled and must enroll in Electronic Funds Transfer (EFT) within 30 days of NaviNet enablement. For additional details, view:
  • Electronic Transaction Requirements
  • NaviNet Provider Portal
• Provider Communications
• Provider Directory
• Highmark Provider Manual
  • Electronic Transaction Requirements
  • Medical Policy
  • BlueCard
  • Contact Information
  • Fraud Prevention
• Claims & Reimbursement - For information on claims, reimbursement and procedures requiring prior authorization, please reference the Claims, Payment & Reimbursement section in the left hand website menu.

Preventive Health Guidelines

Highmark continually strives to enhance the quality of care and service to our members. One of the ways this is accomplished is via the Highmark Preventive Health Guidelines. The guidelines are reviewed annually and updated to ensure they remain current with national guidelines, as well as with national, regional and local standards of medical care. The guidelines are distributed to the practitioner community as a reference tool to encourage and assist you in planning your patients’ care. Coverage of the preventive/wellness benefits are subject to the terms of the member’s benefit plan.

To help make the information more accessible and convenient for you, the complete set of Preventive Health Guidelines are available here on the Provider Resource Center under EDUCATION/MANUALS. 

Thank you for your support and for providing high-quality care to our members, your patients. Welcome to Highmark Blue Cross Blue Shield of Western New York - we look forward to working with you!

Note: If you are not yet contracted with Highmark and are interested in participating in our provider networks, you can start by selecting CREDENTIALING from the main menu on the left.