Step Therapy Prior Authorization for Hyaluronan Treatment

As of January 1, 2023, step therapy prior authorization requirements apply to select medical injectables related to hyaluronan treatment for Medicare Advantage (MA) members. This change will align with the requirements already in place for Highmark Blue Cross Blue Shield of Western New York members covered by commercial and Affordable Care Act (ACA) plans. Click to read more .

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UPDATE: Transition to New Utilization Management Tool On Hold

The transition to our new utilization management (UM) tool is now on hold for Highmark Blue Cross Blue Shield of Western New York. Once we have a new implementation date, we will communicate that to our providers. For more information, click here .

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Prior Authorization Changes Postponed

Highmark Blue Cross Blue Shield of Western New York (BCBSWNY) is postponing authorization requirement changes for some musculoskeletal (MSK) procedures and interventional pain management, molecular and genomic testing, and radiation oncology services for all lines of business for the foreseeable future.

Educational webinars will be rescheduled. We will send updated registration information and webinar dates prior to implementation of these eviCore programs. To read the entire Special Bulletin, go here .

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Transition to MCG

Effective February 13, 2023, Highmark incorporated MCG Health clinical guidelines into our criteria of clinical decision support, replacing Change Healthcare (InterQual). This change is being made to align the clinical review processes and platforms for Highmark health plans. To learn more, go here .

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Telemedicine and Telehealth Update

Highmark is changing Reimbursement Policy-046: Telemedicine and Telehealth Services (RP-046) to again allow reimbursement for the following codes: 99446, 99447, 99448, and 99449. This update is for all commercial lines of business effective February 20, 2023. For more information, go here .