As part of the affiliation, Highmark Blue Cross Blue Shield of Western New York updated its billing requirements for electronic behavioral health services claims. To avoid claim denials and help you get paid correctly, behavioral health providers must now include the correct taxonomy and performing provider information (when applicable) when submitting 837P electronic claims.
The following guidelines apply for both your Highmark Blue Cross Blue Shield of Western New York legacy system and Highmark system patients.
Individual providers who are credentialed with Highmark Blue Cross Blue Shield of Western New York must include the NPI number and taxonomy of the billing provider in the billing provider loop.
NOTE: You must use the taxonomy code that corresponds with the specialty type of the billing provider group:
Individual credentialed providers must also include the NPI number and taxonomy code of the performing provider in the performing/rendering provider loop.
The following provider types should bill in this manner:
Providers who are covered under a billable group (not individually credentialed with Highmark Blue Cross Blue Shield of Western New York) and bill using a CMS 1500 claim form must include the NPI number of the billing provider group along with taxonomy code 101YM0800X.
NOTE: The rendering provider loop must remain BLANK. You do not need to include an NPI number or taxonomy code in this loop.
