Professional Providers Moving to Group Contracts

Highmark Blue Shield (BS) is beginning the process of moving professional providers in its New York markets onto Highmark Professional Agreements — which are group contracts that match the structure that is in place in the other Highmark service regions.

Provider groups with newly contracted individual practitioners began receiving Highmark Professional Agreements(s) on December 4, 2023. Practices without newly contracted individual practitioners should start seeing the new contracts in their email inboxes in the second quarter of 2024.

Key Information

Here are some things to know:

  • The Highmark Professional Agreements apply to all professional providers who want to participate in our networks and will apply to both group practices and individual practitioners. The agreements govern all providers affiliated with a specific Tax Identification Number (TIN). Each individual practitioner is no longer required to sign his/her own agreement. Highmark uses this structure for ease of administration for the provider group and for Highmark.

  • You may receive two contracts: one for Medicare Advantage plans and another for all non-Medicare health plans.
    • Note: If Highmark has delegated management of any product to a third party, the terms of the contract in place with any such management contractor will control.

  • Your reimbursement rates will not change. The process of moving from individual to group contracts is not an opportunity to renegotiate your rates with Highmark.

  • Participating professional providers can view the standard allowances on the Provider Resource Center (PRC) through Availity® or NaviNet®. From the secure PRC home page, click CLAIMS, PAYMENT & REIMBURSEMENT in the left-hand menu and then Fee Schedule Information.

For more information, read the recent Special Bulletin.


 

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