Medicare Advantage: Quest No Longer Exclusive Lab for Outpatient Services

Quest Diagnostics is no longer the required outpatient laboratory for Medicare Advantage members in New York state. Highmark Blue Cross Blue Shield and Highmark Blue Shield members in both the Medicare Advantage HMO and PPO plans are now able to use any in-network labs for outpatient laboratory services. This change went into effect on January 1, 2024. For more information, click here.

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UM for SNF, IRF, and Inpatient Hospice Being Integrated into Helion Arc

Effective April 1, 2024, Highmark Blue Shield is integrating Helion Arc into the utilization management (UM) process for the following services and lines of business:

Services	Lines of Business
Skilled Nursing Facility (SNF)	Medicare Advantage and Commercial
Inpatient Rehabilitation Facility (IRF)	Medicare Advantage and Commercial
Inpatient Hospice	Commercial only

This change will result in faster approvals for prior authorization requests, submitted electronically, for appropriate services. To learn more, go here.