Short Takes: COVID-19 Boosters, EDI Update, and More

Short Takes: COVID-19 Boosters, RSV Vaccine for Pregnant Women, and More

The Centers for Disease Control and Prevention (CDC) has recently approved new, single-dose COVID-19 booster vaccines from Pfizer, Moderna, and Novavax to protect against the XBB variant. The Pfizer and Moderna boosters are for all persons 6 months and older; the Novavax vaccine is for individuals 12 and older. For more information, click here.

UPDATE: RSV Vaccine Now Approved for Pregnant Women

The Centers for Disease Control and Prevention (CDC) has approved respiratory syncytial virus (RSV) vaccines for infants, pregnant women, and adults 60 years of age and older. These vaccines are being retroactively added to the Highmark Preventive Schedules. Click hereto read the updated Special Bulletin.

New BlueCard Fax Number for Medical Records Requests

The BlueCard fax number for Medical Records is 1-833-619-5751. This new number will appear on medical records request letters, which include a barcode for identification purposes. Providers will need to fax back the requested medical records and the original medical record letter that features the barcode. This will help avoid delays. If the medical records are received without the letter or barcode, they will be sent to general correspondence instead of being sent directly to the home plan.

Note: This new fax number is only to be used for sending back BlueCard medical records.

FEP Claims Will Be Reviewed by Clinical Editing Tool Starting January 1, 2024

To align with our internal claim review process, Highmark Blue Shield (BS) will start using a clinical editing tool to analyze Federal Employee Program (FEP) claims, effective January 1, 2024. Clinical editing is an effective and efficient method for quickly reviewing and approving correct claims, while also identifying errors on incorrectly coded claims during the prepayment process. For more information, click here.

All Highmark Member Claims Must be Sent to Highmark Blue Shield

As a reminder, network providers must submit all claims for patients covered by Highmark to Highmark Blue Shield (New York).

This includes patients enrolled with:

  • Highmark Blue Cross Blue Shield (Pennsylvania)
  • Highmark Blue Shield (Pennsylvania)
  • Highmark Blue Cross Blue Shield (West Virginia)
  • Highmark Blue Cross Blue Shield (Delaware) and Highmark Health Options (Delaware)

Please note that if Highmark is listed on the front or back of a patient’s ID card, these claims must be submitted to Highmark Blue Shield. For more information, click here.

Error Corrected: Medical Policy S-248 Nerve Ablation and Injection

There was a typing error in the September 4, 2023, published version of S-248 Nerve Ablation and Injection. The Genicular Nerve Block section of the policy was inadvertently placed into the Genicular Nerve Radiofrequency Ablation section. The policy has been corrected and published on September 27, 2023.

Medical Policy Update Newsletter

The October newsletter is available here.