A newsletter for Highmark Blue Cross Blue Shield providers in western New York
Issue 7, July 2024
The standard professional quarterly fee schedules were published on July 26, 2024. The Corporate Drug Fee Schedules files have been divided into two fee schedules:
To view the quarterly fee schedules on the Provider Resource Center (PRC), log into Availity®
. Click Payer Spaces > Your Highmark Plan > Provider Resource Center.
Once you arrive at the PRC, choose CLAIMS, PAYMENT & REIMBURSEMENT from the left menu and click Fee Schedule Information.
Effective Aug. 19, 2024, Express Scripts Pharmacy will no longer stock a limited set of medications for all lines of business. Members currently receiving impacted drugs will have the option to fill an alternative drug at Express Scripts home delivery, but those who want to or need to continue filling the impacted drugs will need to do so from an alternative, in-network retail pharmacy. For more information and to see the list of impacted medications, click here.
Highmark Blue Cross Blue Shield is beginning the process of moving professional providers in its New York markets onto Highmark Professional Agreements. Group agreements will reduce the administrative burden of requiring each practitioner to sign an individual contract. Instead, the practice will sign for all participating practitioners. Once your office receives your group contract, we ask that you sign it and send it back promptly.
Highmark is hosting a live webinar on Aug. 15 from 12 to 12:45 p.m. EST. This webinar will focus on Mental Well-Being powered by Spring Health, a behavioral health solution offering expanded access to high-quality providers for every level of care.
This program is ideal for patients seeking timely care, as first appointments are generally available within 3-5 days. To register, click here.
Effective Aug. 1, 2024, Highmark Blue Cross Blue Shield is requiring prior authorization for inpatient and outpatient musculoskeletal (MSK) procedures. New and continuing authorization requirements for inpatient and outpatient MSK services will be managed directly by Highmark Blue Cross Blue Shield.
These changes apply to Highmark Blue Cross Blue Shield members enrolled in our fully insured Commercial, Medicare Advantage, Affordable Care Act (ACA) plans, and members of select self-insured (Administrative Services Only) groups.
To learn more, click here.
Beginning August 2024, Highmark will welcome Free Market Health (FMH) into our pharmacy market in our New York regions:
Free Market Health’s care driven marketplace seamlessly connects members to a curated selection of high-quality specialty pharmacies. FMH's technology platform enables us to make sure our members receive the most clinically appropriate care at the most competitive pricing.
To learn more, click here.
The 28th edition of MCG’s Care Guidelines will be available on Aug. 1, 2024.
After that date, you will be able to submit authorization requests using the 28th edition for any new requests. Any authorization requests with a start of care date prior to Aug. 1, 2024, will be reviewed using the 27th edition.
Please continue to use the Predictal application in Availity® to submit authorization requests with clinical information included.
Highmark Blue Cross Blue Shield in Western New York is pleased to announce our plan to expand our collaboration with Wellpoint Partnership Plan, LLC (formerly Amerigroup Partnership Plan, LLC) to administer and manage services for our Essential Plan members. We are preparing for this transition to be effective Jan. 1, 2025. For more information, click here.
