- Latest Updates
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Special Bulletins HBSPA
- Prosthetics & Orthotics in DE PA and WV
- Annual Update to Fee Schedule & Pricing Methodology
- Two New Types of Associate MHP in PA & DE
- Additional Documentation for Quality Improvement
- New Inpatient Facility Diagnosis Guidelines
- Inadvertent Claim Denials for Physical Medicine Services
- National Asthma & Allergy Awareness Month
- Quick Claims Functionality in Availity
- National Infant Immunization Week
- Reimbursement Changes for Respiratory Panels
- Changes to Rx Processing
- Highmark Responds to Change Healthcare Cyber Event
- CHIP Coverage Includes Allergy Medications
- National Nutrition Month
- Highmark Participating Providers Impacted by Change Healthcare Cyber Event
- CoverMyMeds Auth Requests
- Change Healthcare Cyber Event
- Heart Health Month
- Hemophilia and Bleeding Disorder Drug Program
- Annual HEDIS® Medical Record Reviews
- Inpatient Admissions
- HEDIS Changes in 2024
- Medical Policy S-558
- 2 Weeks to Highmark’s Transition to Availity
- Medical Policy S-60
- CDC Adds Meningitis
- Federal Employee Program
- Medicare Part D
- Acute Care Facilities
- Transition From NaviNet to Availity
- MID Program Changes
- Claims Culprit
- Physical Medicine Management
- Prior Authorization Changes March 2024
- New NAIC Code for SEPA
- U.S. Antibiotic Awareness Week
- Medical Policy S-9
- National Diabetes Awareness Month
- Reminder: 24/7 Availability Requirements
- ICD-10 Exclusionary Codes
- Self-Service Tools
- CPT Category II Codes for Diabetes
- New COVID-19 Booster Vaccines
- EDI Update: Highmark Accepting 275
- RSV Vaccines
- FEP Claims
- Use of Self-Service Tools
- New Credentialing Enhancements
- HEDIS Measure
- Annual SPH Analytics Survey
- Return Reissued Contracts
- DELAYED: Pharmacy Authorization Submissions
- Annual Update to Highmark’s Professional Fee Schedule
- Physical Medicine Management New High
- Central PA Teamsters
- New Medicare Advantage Rates
- Medical Policy U-5 Assisted Reproductive Technology
- Paper Claims
- Use of Self-Service Tools
- Update: Stabilize and Transfer
- New Capabilities Added to Provider Data
- Reminder: Submitting Auth Requests
- Important Reminder: Include Rendering
- NEW! Enhanced Clinical Documentation
- Improving Diabetes Treatment
- RP-019N Update: Generics and Biologicals
- Prior Authorization List Update
- Medicaid Redetermination
- New Start Date for Emergency Department
- Upcoming Prior Authorization Changes
- May Is National Asthma Month
- Changes to Sleep Apnea-Related Medical Policies
- National Infant Immunization Week
- Public Health Emergency
- April is Alcohol Awareness Month
- New Provider Data Maintenance Tool
- Medical Injectable/Specialty Drug
- PA CHIP Eligibility Transitioning
- 2023 Office and Outpatient Evaluation
- Prior Authorization Soon Required
- Authorizations for Home Health
- March Is Colorectal Cancer Awareness Month
- Four RPs to be Updated
- New RP-075
- Evidence-Based Recommendations
- Reimbursement for Codes
- Medicare Advantage Medical
- New Resource for Coding
- Highmark Members Using Populytics
- Medicare Advantage Medical Policy Z-105
- Submitting Fractional Numbers
- MCG Go-Live Next Week
- Reprocessing Effort for July
- December Formulary Updates
- Discontinued: FPH Network’s
- Emergency Department Room Claim Audits
- National Children’s Dental Health Month
- MCG Transition Date Moved
- New Providers Can Submit Credentialing
- Mental Wellness Month
- Medical Policy E-15
- Right Care Measures
- New UM Tool
- Cervical Cancer Awareness Month
- Decreased Reimbursement for Certain X-Ray Services Reported with Modifier FY
- Reimbursement Policy-046: Telemedicine and Telehealth Services Updates
- Update to the Behavioral Health Toolkit
- Step-By-Step Guide for Provider Attestation Posted on the Resource Center
- Fee Schedule Publication
- Medicare Advantage Medical Policy Search
- MCG Clinical Criteria
- Behavioral Health Will Soon Be Routed
- Highmark Transition to MCG Health
- Medical Policy Z-64
- Upcoming Prior Authorization Changes
- Behavioral Health Toolkit For Primary Care Physicians
- Delays In Faxed Authorizations
- Medicare Advantage Medical Policy N-38
- October Formulary Updates Now Published
- Inflation Reduction Act Part D Coverage
- Echocardiogram Code
- Medicare Advantage Medical Policy N-48
- National Influenza Vaccination Week
- WholeHealth Living’s Rapid Response System
- Upcoming Prior Authorization Changes
- Two Injectables to Require Prior Authorization
- Pre-Approvals not Required for Authorizations Submitted Between 8/22 - 10/3*
- June Formulary Updates
- New Dates Added! Provider Webinar: Submitting Electronic Inpatient Authorizations
- Interactive Voice Response Expansion
- Submitting Claims
- Update Medical Policy E-17
- Join Provider Webinar: Submitting Electronic Inpatient Authorizations
- Highmark To Introduce Therapy Bundles
- National Immunization Awareness Month
- Synagis and All Other Drug Procedure Codes Reviewed by Highmark
- 2022 Interqual Level Of Care Criteria Release
- Delay in Publication for Medical Policies Z-8, Z-64, and M-62
- Rp-040 List of Routine Supplies and Services
- Five Injectables to Require Prior Authorization Beginning January 1, 2023
- More Than A Dozen MS Drugs
- HHS-RADV Audit
- Member Support Programs Available for Alcohol Use Disorder and OCD
- Breast Cancer Awareness Month Starts October 1
- April Formulary Updates Now Published
- Repost New Kidney Care Management Program
- Updated Medical Policy S-36
- Outpatient Services Ancillary DME
- ICD-10 Exclusionary Codes
- Medicare Advantage Providers - 2023
- Diagnosis Code Header
- Enhancements to eviCore Authorization Process
- Outpatient Services Ancillary DME and eviCore
- MCG Chosen as Utilization Management
- CPT Category II Codes
- Authorizations Section Added to P R C
- Fax Numbers for Unsolicited Documentation
- Authorization Letters Available in NaviNet
- Medicaid Plan Selection Does Not Affect Chip Plans
- Daily Maximum to Increase for Therapy Services
- Prior Authorization No Longer Needed
- August Formulary Updates Now Published
- New Go-Live! Authorizations will Soon be Required for OOA and OON Musculoskeletal, Genetic Testing, and Radiation Oncology Services
- The Role of Imaging in Low Back Pain Examinations
- New Initial Inpatient Authorization Approvals Valid Longer and Concurrent Reviews due Later
- RP 040 Update: New Items Added to Routine Supplies and Services; Additional Guidance Provided
- Authorization Period for Most Outpatient Services Extended to 180 Days
- Providers Outside of Pennsylvania – File Claims Through Bluecard for Performance Blue Products
- U. S. Digestive Health Out Of Network For Highmark Members Starting July 1, 2024
- Electronic Authorization Tool Update: Enhanced Functionality and Important Reminders
- Rate Change: Five Drugs in the Medical Injectable and Site of Care HIT Programs
- Diabetes Distress A Common
- Highmark Will Implement A Prepayment Edit
- Prior Authorization Changes Sept 2024
- Change Healthcare Cyber Incident – Data Breach Announcement
- How To Submit Prior Authorization Requests for Outpatient Physical Medicine Services
- Reimbursement for LCSWS Will Return to Previous Rate
- Express Scripts Pharmacy to No Longer Stock
- New Go-Live Date! Authorizations Required for OOA and OON Musculoskeletal
- Error Corrected: Place of Service Updated for Medical Policy I-283
- Annual Phone Survey to verify Provider Directory Information
- August is National Immunization Awareness Month
- Farxiga Added to Medicare Formularies as a Tier 3 Preferred Brand Name
- Tips for Submitting Corrected Claims
- Error Corrected: Medical Policy S-269 to be Updated on Aug. 12
- Revised Prescription Medication Policy for Weight Loss Medications
- Medicare Advantage Medical Policies Are Once Again Accessible from the PRC
- Physical Medicine Management: High Performing Network Program Update
- Express Scripts Pharmacy to No Longer Stock 32 Medications
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Special Bulletins HBSPA
Special Bulletins
These important communications keep you up to date on the latest updates and changes impacting your practice. They supplement our monthly newsletter, Provider News, which conveys important product, policy, and administrative information, including billing, claims, and program updates.
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