Information on this Provider Resource Center site is for members who have moved onto Highmark's systems.For information related to members who have not moved onto Highmark's systems, please visit bsneny.com/provider.
Upcoming Prior Authorization Changes
Two Injectables to Require Prior Authorization Beginning March 1, 2023
Corrected: Updated Medical Policy S-36 Includes Omitted Diagnosis Code
Authorization Changes Postponed for MSK Procedures, Molecular and Genomic Testing, and Radiation Services
Enhancements to NaviNet Preauthorization Experience
Attention: Medicare Advantage Providers - 2023 Formulary Changes
MCG Chosen as Utilization Management Clinical Criteria Vendor
Report Site Issues
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.