Credentialing policy information for new providers who are credentialing with Highmark Blue Shield of Northeastern New York and providers who are recredentialing with Highmark BSNENY can be found in Chapter 3 (Provider Network Participation) of the Highmark Provider Manual.
NEW PROCESS FOR ENROLLMENT
Providers can enroll in our health plan by completing the Initial Credentialing Request Form and registering with the Council for Affordable Quality Health Care (CAQH).
How it Works:
Follow this link to access the CAQH. (Previously referred to as the Universal Provider Datasource.)
- Under Provider Sign In, enter your username and password if registered, or select register now.
- Enter your CAQH Provider ID. (If you don't know it, call CAQH at 1-888-599-1771).
- Enter or update your information.
- Authorize Highmark BSNENY to access your information electronically.
For complete information on Professional Provider credentialing with Highmark BSNENY, CLICK HERE.
Dental Providers – IMPORTANT
Dental Providers who intend to bill for both medical and dental services for Highmark Blue Shield of Northeastern New York members will need to follow a new process to be credentialed and contracted.
Attention NY Dental Providers: Effective October 1, 2023, any updates to your practice or provider information will be handled by United Concordia Dental (UCD). Please use the following form to contact UCD and update your information: https://www.unitedconcordia.com/pifria/
- Note: By clicking the link above, you will be leaving a Highmark website.
Any questions regarding this process should be directed to UCD at 800-307-8514.
Dental providers who bill medical services for Highmark Blue Shield of Northeastern New York members should continue to provide updates to Highmark using our Provider Information Management Forms on the Provider Resource Center.
Professional Providers – Recredentialing
NEW PROCESS FOR RECREDENTIALING
When a practitioner is due for recredentialing, a notification letter will be sent. Once the Professional Provider has attested to and updated their information in CAQH, there is nothing else the provider needs to do.
You can always reference the Highmark Affiliation FAQs for more information.
NEW PROCESS FOR ENROLLMENT
To begin the credentialing process, Facility/Ancillary (Organizational) Providers are expected to complete the Initial Application for Facility and Ancillary Providers.
- Highmark credentials Facility/Ancillary (Organizational) Providers at each location. When an existing entity is adding a new location, the new location must be credentialed before network participation.
For complete information on Facility/Ancillary (Organizational) Provider credentialing with Highmark BSNENY, CLICK HERE.
BEHAVIORAL HEALTH PROVIDERS
For help identifying Behavioral Health Organizational Providers, read the Highmark Provider Manual Chapter 4, Unit 2: Behavioral Health Providers, section 4.2 Levels of Care.
Please use the following to help you start the credentialing process:
Facility/Ancillary (Organizational) Providers – Recredentialing
Facility and Ancillary (Organizational) Providers who have recently received a Facility and Ancillary Recredentialing Announcement letter should use the Recredentialing Application for Facility and Ancillary Providers Form to begin the recredentialing process.
Professional and Facility/Ancillary (Organizational) Providers will be able to report information by completing specific electronic forms.
Additional Resources For Providers
ALL PROVIDERS
PROFESSIONAL PROVIDERS
FACILITY/ANCILLARY (ORGANIZATIONAL) PROVIDERS
Last updated on 12/8/2023 9:51:49 AM