Claims filed for 2015 dates of service with these alpha prefixes must be submitted with naic code 15460. Do not use this form to ask questions about your health coverage or to provide confidential personal health information. Highmark blue shield, highmark senior health company, highmark choice company, highmark senior solutions company and hm heath insurance company are independent licensees of the blue cross and blue shield association. These changes were previously communicated via plan central messages dated june 15, 2015, and again, with supplemental information, on aug. Authorization process changes for urgentunplanned inpatient requests. Were here to help you and your patients stay informed, make a plan, and stay safe. Refer to highmark reimbursement policy bulletin rp001, assistant at surgery services for additional information on reimbursement coverage. Determine what needs a preauthorization and how to submit a preauthorization request. For accommodation of persons with special needs at sales. Highmark provider manual health options provider manual medical policy. In addition, helpful tips are offered to assist in providing the needed information for each. If you have any questions or need additional assistance, please contact your provider account liaison or clinical transformation consultant. Submit a claim, check claims status and edits, verify member benefits and eligibility.
Blue cross medicare advantage section of the blues provider reference manual. Highmark west virginia medical and behavioral health. Blue cross and blue shield of north carolina bcbsnc is pleased to provide you with this edition. Provider news issue 1, 2020 provider resource center. Review the latest provider administration manuals, medical policies and guidelines to find information about how. In addition, helpful tips are offered to assist in providing the needed information for each facility type. Welcome to the florida blue manual blue cross and blue shield of florida, inc. For additional online resources, view our provider link list, available at. Highmark 2015 penn state office of human resources highmark blue shield is an independent licensee of the blue cross and blue shield. Highmark, and its affiliates, operate health insurance plans in pennsylvania, delaware and west virginia that serve 5. September, 2018 blue cross blue shield of wisconsin. Anthem blue cross and blue shield provider manual co page 10 of 196 revised.
Highmark blue shield launches community blue medicare hmo. In august 2012, highmark introduced the telemedicine service benefit to certain members. For questions about our company or website, use the mailing address provided or fill out the form below. The information in this unit is applicable to pawv providers only. Medicare advantage medical policy bulletin highmark. This website is operated by horizon blue cross blue shield of new jersey and is not the health insurance marketplace website. Nov 23, 2015 highmark medicare services part b quick reference. The blue cross and blue shield symbols are registered marks of the blue cross and blue shield association, an association of independent blue cross and blue shield. For the best performance and security, always keep your web browser uptodate. Any section of this manual may be updated at any time. Facility manual, which is available on the provider resource center prc under facility information. Th manual is for physicians, hospitals, ancillary e providers and facilities participating in.
This booklet provides a list of blue rx pdps network pharmacies. Camp hill highmark blue shield announced today that it will launch community blue medicare hmo, a highquality, lowercost medicare advantage option for seniors in 14 central and northeastern pennsylvania counties for coverage effective jan. For a coverage effective date of january 1, 2015, blue cross and. Do not use this mailing address or form for provider inquiries. For a list of changes that were made to the provider manual, please refer to the revision history, which outlines the revision dates, a brief description of the changes, and the sections of the manual that were affected. Pennsylvania highmark blue cross blue shields nepa service region will be credentialed and recredentialed based on highmark credentialing policies and procedures. For more information call 18668566166 seven days a week from 8. Contact us today at 18666778565 tty users call 711, 8 a. Medical policy and precertification preauthorization information for outofarea members. Highmark blue cross blue shield, highmark senior health company, highmark choice company, highmark senior solutions company and hm heath insurance company are independent licensees of the blue cross and blue shield association. It is contracted to manage a network of dental providers for highmark and highmark health insurance company. May 21, 2012 anthem blue cross and blue shield provider manual nv directory of servicesprovider resource information.
Highmark blue shield logo will be shown on the ras and eobs. Our vision is to ensure that all members of the community have access to affordable. Find information about contracting and credentialing. If you are a highmark plan member with questions about your coverage, call the member service number on the back of your insurance card hours vary.
Communications and resources in blue cross mn payer spaces. Proactive and timely update of your provider records. Billing highlights for facilities provider resource center. If you arent clear about any of the underlined terms used in this. Anthem blue cross and blue shield is the trade name of anthem insurance. Blues provider reference manual blue cross blue shield of new.
These guidelines are the proprietary information of highmark. Blue cross complete provider manual pdf blue cross blue shield. Substance abuse, 2015 substance abuse and mental health services administration samhsa a. See medicare advantage medical policy bulletin n116 for additional information on assistant surgery performed by a physician assistant. Access our procedure manuals and benefit guidelines. Feb 05, 2020 new for 2020 highmark is committed to working with you to improve and maintain our members health and will participate in the interplan medicare advantage care management and provider engagement program for out of area ooa blue cross blue shield plan members hosted by highmark.
The blue cross and blue shield names and symbols are registered service. Highmark health options is a highmark blue cross blue shield delaware. Florida blue may notify providers of updates in a variety of ways, depending upon the nature of the update, including mailings, publication in blueline, our provider newsletter, or posting to our website at to access the provider manual information click the buttons below. Highmark blue cross blue shield member can obtain information about network providers. The documents provided here identify the information from the ub04 locator fields that is required when billing specific facility type claims to highmark blue shield. This provider manual will present a general overview of information regarding key. This site works best if viewed with the latest version of internet explorer, firefox, chrome, or safari browsers. A sales person will be present with information and applications. Anthem blue cross and blue shield provider and facility manual. To request a medicare provider andor pharmacy directory, please fill out the form on the right. Highmark blue cross blue shield delaware is an independent licensee of the blue cross blue shield association, an association of independent blue cross and blue shield companies. Highmark blue shield announced today that it will launch community blue medicare hmo, a highquality, lowercost medicare advantage option for seniors in 14 central and northeastern pennsylvania counties for coverage effective jan. Provider news is the bimonthly informational newsletter for health care professionals and facilities that contains valuable news, information, tips and reminders about the products and services of highmark blue cross blue shield west virginia. Not only do we give you access to one of the largest network of providers.
Corrine satriano program manager highmark blue cross. Any sale, copying or dissemination of the medical policies is prohibited. Attorneys fees and costs the shared fees and costs of the nonbinding mediation and arbitration e. Effective november 1, 2015, the ongoing monitoring process applies to practitioners in highmark blue cross blue shields northeastern pennsylvania. The provider manual is located in the current publications section of independence navinet plan central. Enter a drug brand or generic name, search by initial letter, or browse by therapeutic class. Find policies and procedures for hospitals and facilities. Organizational provider participation facility ancillary unit 5. Blue cross blue shield bcbs plans across the country and in more than 200 countries and.
Blue shield of california provider network tools and resources at your fingertips find information about working with us to provide care for our members during the covid19 public health emergency. Click here for more provider information provider news issue 1, 2020 now available. Hm health insurance company is a pdp plan with a medicare contract. Highmark blue cross blue shield choose health care providers. No fee schedules, basic units, relative values or related listings.
August 2015, effective november 15, 2015 july 31, 2016 a. Health savings blue ppo 2750 a community blue flex plan coverage period. Highmark health options is an independent licensee of the blue cross and blue shield association, an association of independent blue cross and blue shield plans. Blue distinction centers for specialty care program. If you arent clear about any of the underlined terms used in this form. Find blue shield forms, policies, benefit information, medical guidelines, operating guidelines, manuals, patient care resources and more. Find policies and procedures for ipas, medical groups and their contracted providers. Highmark provider manual medical policy medical policy medical policies. Securityblue welcome welcome to securityblue, a medicare advantage coordinated health care plan from keystone health plan west, inc. Bluecross blueshield of tennessee clinical practice guidelines. Highmark blue cross blue shield delaware is an independent licensee of the blue cross blue shield association, an association of independent blue cross and blue shield. Access the policies and procedures manuals, dental, medical and behavioral policies.
Highmark blue cross blue shield west virginia is an independent licensee of the blue cross blue shield association, an association of independent blue cross and blue shield plans. This website does not display all qualified health plans available through the health insurance marketplace website. In missour this manual is designed to assist you with education about bluecard and interplan business. Providers in need of assistance should contact provider services at 8002415704 tollfree. Important information regarding the use of this manual welcome to the florida blue manual blue cross and blue shield of florida, inc. Highmark has been helping our community in good times and in bad. The highmark provider manual, first published in april 2018, is the result of the consolidation of the former highmark blue shield office manual for professional providers and the highmark facility manual the consolidation simplified and improved the experience for our participating providers by providing one comprehensive resource for all provider types. Highmarks mission is to be the leading health and wellness company in the communities we serve. With providers to help offer the highmark blue cross blue shield providers. The following alpha prefixes will be assigned to highmark senior health company freedom blue ppo members beginning jan. Community blue medicare hmo plan provider directory. Highmark blue cross blue shield west virginia providers. You will go to the united concordia website where you can start your search.
In 2015, our network gives you access to highquality. Major events blue ppo 6600 a community blue plan coverage period. The program aims to improve care management and data sharing. This benefit provided access to 247 virtual pcptype care through our. For medical policy and claims administration updates, including coding guidelines and procedure code revisions, be sure to read the medical policy update. These services are reported in accordance with cpt guidelines i. Highmark senior health company, highmark choice company and highmark senior solutions company are medicare advantage plans with a medicare contract.
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