The first quarter of 2023 will usher in a number of changes for providers who serve members covered by Highmark Blue Shield of Northeastern New York. Among the processes and programs being affected are the following:

  • Provider Service Phone Numbers
  • Preventive Services
  • Medicare Advantage (MA)
  • Telehealth Billing

Provider Service Phone Numbers

Effective February 1, 2023, please call 800-950-0051 for Provider Service and 844-945-5503 for Highmark Blue Card Provider Service. After February 1, all other phone numbers will be discontinued.

Preventive Services

Beginning January 1, 2023, members will be covered by Highmark’s preventive services schedule. Some labs previously considered preventive with a $0 cost-share for your Highmark Commercial and MA members will now be subject to your members’ regular cost-shares and deductibles only when the lab is billed with a medical diagnosis.

For more information, go here .

Medicare Advantage

Several changes will be happening for Highmark’s Medicare Advantage population including:

  • MA Members Moving onto Highmark’s Systems: As reported in October Provider News, all Medicare Advantage members will move onto Highmark’s system effective January 1, 2023.
  • Prescription Medications: Effective January 1, 2023, Highmark will be making changes to the medications covered on the formularies that may affect your Highmark MA members. For more on these MA medication changes, go here .
  • Vaccines and Insulin: As a result of the Inflation Reduction Act, the Centers of Medicare and Medicaid Services will begin requiring the following coverage for MA members beginning January 1, 2023:
    • Adult preventive vaccines recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) must be provided under Medicare Part D at $0 coverage.
    • Insulin guidelines:
      • Members who receive insulin through Medicare Part D will be charged no more than $35 per a month’s supply. IMPORTANT: Some insulins may cost less if the member is part of the Part D Senior Savings Model.
      • Insulins covered by Medicare Part B will be covered at the $35 rate as of July 1, 2023.
      • For more on these changes, go here .

Telehealth Billing

All New York providers will be adopting Highmark’s telehealth reimbursement policy effective January 30, 2023. When conducting virtual visits, include one of the following:

  • Place of Service (POS) 02 – The member is in a location outside of their home at the time they received telehealth services.

  • POS 10 – The member is in their home (a location other than a hospital or other facility) at the time they received telehealth services.

For more information, go here .

 

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