Expanded Credentialing Section: More Electronic Options

Starting May 28, 2023, the Credentialing section on the Highmark Blue Cross Blue Shield of Western New York (BCBSWNY) Provider Resource Center (PRC) will be expanding, offering additional electronic resources to streamline the credentialing process for professional and organizational providers.

The expanded Credentialing section will enable medical providers to complete multiple credentialing forms and processes electronically from one web location, while eliminating the need to fax or email multiple forms.

Dental-only providers will need to credential via the United Concordia site .

Network providers who deliver both medical and dental services will need to credential via both Highmark and United Concordia .

Additional Credentialing Resources

Beginning on May 28, 2023, the Credentialing landing page on the Highmark BCBSWNY PRC will feature additional resources, including:

  • Professional Initial Credentialing Set Up
  • Organizational Initial Credentialing Set Up
  • Organizational Behavioral Health Initial Credentialing Set Up
  • Organizational Credentialing Forms

To access the landing page, select CREDENTIALING from the left menu and then click Credentialing. xx

The expanded landing page will feature additional Credentialing resources for professional and facility providers, including:

I. Professional Initial Credentialing Set-Up

Once the new landing page is live, professional providers will no longer complete the New Provider Enrollment and Disclosure Form. The Provider Enrollment Application Checklist will be replaced with an Initial Credentialing Provider Checklist.

In addition, providers can use this page to:

  • Obtain Council for Affordable Quality Healthcare (CAQH) ID (also known as the Universal Provider DataSource): If you are NOT currently participating in CAQH ProView, please go here to obtain a CAQH ID and complete the application.
    • Important Reminder: After you update any information in your CAQH profile, you must complete the attestation, so that your authorized organizations can view your updated profile.
  • The Initial Credentialing Request Form: This form allows professional providers to become credentialed with Highmark.
    • Important: You must provide a CAQH ID to Highmark in order to start the credentialing process.
  • Check for a Confirmation Email from Highmark. Highmark will keep an electronic copy of your CAQH ProView profile in its database and will send you a confirmation email. Following New York state regulations, Highmark can take up to 60 days to complete your initial credentialing application. However, please note that the 60-day period is contingent upon receipt of a completed application.

II. Organizational Initial Credentialing Set-Up

On this page, three hyperlinks will be available:

  1. Initial Application for Facility and Ancillary Providers: This application is for Facility and Ancillary Providers, including Ambulance, Ambulatory Surgery Centers, Home Health Agencies, Durable Medical Equipment (DME) providers, Laboratories, and Specialty Pharmacies.

    Note: Facility/Organizational entities require a separate credentialing application for each location. When existing entities add a new location, they must be credentialed before network participation.

  2. Special Consideration Process: Select specialties are closed to network enrollment; those affected providers can apply for “special consideration.” This process requires providers to report more information. Interested providers can complete the Special Consideration Questionnaire, which will be reviewed by the Contracting Department.

  3. Facility Credentialing: Urgent Care Centers, Medical Aid Units, and Retail Clinics will complete the Urgent Care Center/Medical Aid Unit and Retail Clinic Application

III. Organizational Behavioral Health Initial Credentialing Set Up

On this page, Organizational Providers who are billing for behavioral health services can:

  • Complete the Behavioral Health Application for Organizational Providers application.

IV. Organizational Credentialing Forms

Under this header on the landing page, there will be the following four forms for Facility and Ancillary providers:

  1. Initial Application for Facility and Ancillary Providers – for providers new to Highmark.
  2. Recredentialing Application for Facility and Ancillary Providers – for providers who have received a letter saying that they must recredential.
  3. Change of Ownership Form – for reporting any changes in ownership which may include provider’s Legal Name, NPI or Tax ID information.
  4. Highmark Facility/Ancillary Change Form – for updating address, phone numbers, and contact information at existing locations for UB-04 Facility Billers, Urgent Care Centers/Medical Aid Unit/Retail Clinics, or Organizational Behavioral Health Billers.

Note: Facility/Organizational entities require a separate credentialing application for each location. When existing entities add a new location, they must be credentialed before network participation.

 

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