A newsletter for Highmark Blue Shield providers in northeastern New York
Issue 4, April 2024
Effective Aug. 1, 2024, Highmark Blue Shield is requiring prior authorization for inpatient and outpatient musculoskeletal (MSK) procedures. New and continuing authorization requirements for inpatient and outpatient MSK services will be managed directly by Highmark Blue Shield.
These changes apply to Highmark Blue Shield members enrolled in our fully insured Commercial, Medicare Advantage, Affordable Care Act (ACA) plans, and members of select self-insured (Administrative Services Only) groups.
Highmark’s List of Procedures/DME Requiring Authorization
will be updated with CPT codes for MSK procedures, including the following services:
Authorization requests should be submitted through Availity®, Highmark’s online provider portal. Once you log in to Availity, you will access the Predictal™ Auto Automation Hub to request authorization for MSK procedures.
OPTION 1: Click Payer Spaces on the task bar and choose your Highmark plan. From Highmark Blue Shield Payer Spaces, scroll down to Applications and click Predictal.
OPTION 2: Click Patient Registration from the task bar, choose Authorizations & Referrals from the dropdown, and then select Authorization Request. You will need to fill in the requested information before being routed to Predictal.
The Provider Resource Center (PRC) has educational guides for submitting authorization requests via Availity. To view the guides, go to PRIOR AUTHORIZATION on the left menu and then click Procedures/Service Requiring Prior Authorization.
If you need assistance regarding electronic authorization workflows, you can email us at ElecAuthSubmit@highmark.com.
Training will be offered to help providers understand the new requirements and processes prior to Aug. 1. More information will be shared on the PRC and in upcoming issues of Provider News.
