Provider Orientation

WELCOME TO HIGHMARK BLUE SHIELD OF NORTHEASTERN NEW YORK!

If you are a newly contracted provider, or a new employee of a network provider's office or facility, we would like to introduce you to the many resources we make available to help you in your interactions with Highmark Blue Shield of Northeastern New York (Highmark BSNENY) and our members. 

Let's begin with some background on Highmark to help you get to know us:

• History of Highmark
• Highmark's Mission, Vision, and Values

And now to get started working with Highmark BSNENY, here is what you need to know: 

• All network providers are required to be Availity-enabled and must enroll in Electronic Funds Transfer (EFT) within 30 days of Availity enablement. For additional details, view:
  • Electronic Transaction Requirements
  • Register and Get Started with Availity Essentials
• Provider Communications - For information on provider communications, please reference the NEWSLETTERS/NOTICES section in the left-hand website menu.
• Provider Directory
• Highmark Provider Manual
  
  • BlueCard (Highmark Provider Manual Chapter 2, Unit 6)
  • Fraud Prevention (Highmark Provider Manual Chapter 6, Unit 8)
• Medical Policy
• Claims & Reimbursement - For information on claims, reimbursement and procedures requiring prior authorization, please reference the CLAIMS, PAYMENT & REIMBURSEMENT section in the left-hand website menu.
• Contact Information

Preventive Health Guidelines

Highmark continually strives to enhance the quality of care and service to our members. One of the ways this is accomplished is via the Highmark Preventive Health Guidelines. The guidelines are reviewed annually and updated to ensure they remain current with national guidelines, as well as with national, regional and local standards of medical care. The guidelines are distributed to the practitioner community as a reference tool to encourage and assist you in planning your patients’ care. Coverage of the preventive/wellness benefits are subject to the terms of the member’s benefit plan.

To help make the information more accessible and convenient for you, the complete set of Preventive Health Guidelines are available here on the Provider Resource Center under EDUCATION/MANUALS. 

Provider Directory

And finally, please be sure to report any changes to us regarding your office, facility, or participating care providers! Visit our Provider Data Accuracy Compliance page for requirements for accurate, up-to-date provider data in our Provider Directory and instructions on how to make any changes to your information on file with us.

The Provider Data Maintenance (PDM) Guide is included there, too, to assist professional providers in reporting changes via Availity and/or NaviNet. And a link to the Highmark Facility/Ancillary Change Form is provided on the page for our participating facilities and ancillary providers.

The Provider Data Accuracy Compliance page is always available under EDUCATION/MANUALS in the left menu.

Thank you for your support and for providing high-quality care to our members, your patients. Welcome to Highmark Blue Shield of Northeastern New York - we look forward to working with you!

Note: If you are not yet contracted with Highmark and are interested in participating in our provider networks, you can start by selecting CREDENTIALING from the left-hand website menu. 

You can also find participation information in Chapter 3 of the Highmark Provider Manual. To access the manual, select MANUALS on the Quicklinks Bar located at the top of the Provider Resource Center. Contact Provider Services in your service area with any questions.