Highmark Blue Shield (BS) is making changes to prior authorization requirements for the Advanced Imaging and Cardiology Services Program.
eviCore’s management of these services for providers in the Highmark BS network will sunset on December 31, 2023. Highmark BS will begin the utilization management of these services effective January 1, 2024. Highmark notified all BS providers on October 2, 2023, via email of this upcoming change.
These prior authorization requirements are subject to the member’s benefit plan.
The medical policies listed here will be established and become effective January 1, 2024.
To help providers prepare for these upcoming changes, Highmark will offer both live and on-demand training. Training dates and information will be posted on the Provider Resource Center and be included in upcoming issues of Provider News.
Leading up to the January 1, 2024 implementation, Provider News will continue to be your source for additional information regarding these changes. If you’re not currently receiving Highmark’s monthly e-newsletter, you can sign up here.
For additional resources on the Provider Resource Center, go to AUTHORIZATIONS on the left menu, click on Procedures/Service Requiring Prior Authorization. If you need assistance regarding electronic authorization workflows, you can email us at ElecAuthSubmit@highmark.com.
The List of Procedures/DME Requiring Authorization for Highmark is subject to change. During the year, Highmark makes several adjustments to the full list of outpatient procedures, services, durable medical equipment, and drugs requiring authorization.