Claims Culprit: Sequela Code Errors Lead to Increased Denials
Federal Employee Program: High-Cost Drugs to Require Prior Authorization
RP-019N Update: Change to New York Reimbursement Direction
Prior Authorization Changes Occurring on March 1, 2024
Post-Acute Care for Landmark Members: Prior Auth Changes Occurring January 1
Highmark Blue Shield Moving New York Providers to Group Contracts
U.S. Antibiotic Awareness Week & World Antimicrobial Resistance Awareness Week
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Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration.
Highmark adheres to the Centers for Medicare and Medicaid Services (CMS) coverage determinations for Medicare Advantage (MA) membership. You're being redirected to the CMS search site.