A newsletter for Highmark Blue Cross Blue Shield providers in western New York
Issue 2, February 2024
Effective April 1, 2024, Highmark Blue Cross Blue Shield is integrating Helion Arc into the utilization management (UM) process for the following services and lines of business:
| Services | Lines of Business |
| Skilled Nursing Facility (SNF) | Medicare Advantage and Commercial |
| Inpatient Rehabilitation Facility (IRF) | Medicare Advantage and Commercial |
| Inpatient Hospice | Commercial only |
This change will result in faster approvals for prior authorization requests, submitted electronically, for appropriate services. Providers will be able to submit electronic preauthorization requests beginning March 21, 2024.
After logging in to the Availity®
portal, providers will begin the electronic auth submission process in the Predictal™ Auto Automation Hub, which will then automatically connect them to Helion Arc to complete the process.
While the process for submitting electronic auth requests may be changing slightly, Highmark’s goal is to minimize provider disruption and ensure that the transition is as seamless as possible, resulting in:
On February 1, 2024, Highmark integrated Helion Arc into the Predictal workflow for UM of outpatient speech therapy. See the recent Special Bulletin for more information. Since April 1, 2023, prior authorization has been required for Commercial Plans for speech therapy (ST) in the Highmark BCBS service area.
To help providers with this upcoming change, Highmark and Helion will offer free, live training sessions during these dates and times:
To register, click the session you would like to attend.
On the Provider Resource Center (PRC), the Procedures/Service Requiring Prior Authorization page has educational guides for submitting authorization requests via Availity.
If you need assistance regarding electronic authorization workflows, you can email us at ElecAuthSubmit@highmark.com.
The List of Procedures/DME Requiring Authorization for Highmark is subject to change. During the year, Highmark makes several adjustments to the full list of outpatient procedures, services, durable medical equipment, and drugs requiring authorization.
