A newsletter for Highmark Blue Cross Blue Shield providers in western New York
Issue 1, January 2024
The Centers for Disease Control and Prevention (CDC) recently approved new vaccines for meningitis and monkeypox (now called mpox) for the 2024 Preventive Schedule effective Jan. 1, 2024. For procedure codes and more information, click here
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Providers will be required to submit itemized bills for high-dollar, inpatient care (costing $50,000 or more) at acute care facilities, effective Feb. 6, 2024, for both local and host (out of area) claims. This new requirement — the previous threshold was $100,000 — is part of an initiative by Highmark to reduce billing and/or payment errors on high-dollar claims that occur both in-network (IN) and out-of-network (OON). For more information, click here.
On Jan. 1, 2023, the final group of HealthNow members was migrated to the Highmark Blue Cross Blue Shield (BCBS) system. Over the past 12 months, Highmark BCBS has worked to efficiently process legacy claims — claims for dates of service that occurred prior to January 1, 2023.
In 2024, processing changes will occur to the following types of legacy claims:
To read more, click here.
Effective Feb. 1, 2024, Highmark is moving utilization management (UM) of outpatient speech therapy to Helion Arc. This change will result in faster approvals for prior authorization requests, submitted electronically, for appropriate services. To learn more, click here.
Effective March 18, 2024, all dental claims — both electronic and paper — for Highmark Blue Cross Blue Shield (BCBS) and Highmark Blue Shield (BS) members must be submitted to United Concordia (UCD). Administrative Services of Kansas (ASK) will no longer accept electronically submitted dental claims (837D) effective March 18, 2024. To read the Special Bulletin, click here.
