Unit 2: Online Resources & Contact Information

1.2 Variety of Informational Resources

1.2 Highmark Websites

1.2 Highmark Provider Directory

1.2 Provider Resource Centers

1.2 Provider Newsletters

1.2 Special Bulletins

1.2 Join Our Mailing List

1.2 Provider Service Center

1.2 Contact Information

1.2 Mailing Addresses

1.2 Disclaimers

1.2 Variety of Informational Resources

Highmark is committed to providing timely and pertinent information about our policies and programs to the provider community. Highmark has a number of easy-to-use electronic sources of information as well as service representatives available by telephone.

Highmark’s Informational Public Websites:

• HighmarkHealth.org
• Highmark.com
• MyHighmark.com - member website for all Highmark regions

Highmark's Provider Resource Centers for all Service Areas are accessible from Highmark.com, MyHighmark.com, and Availity^®:

• Delaware Provider Resource Center
• Northeastern New York Provider Resource Center
• Pennsylvania Central, Southeastern, and Northeastern Region Provider Resource Center
• Pennsylvania Western Region Provider Resource Center
• Western New York Provider Resource Center
• West Virginia Provider Resource Center

The website links above will take you to the current Provider Resource Center (PRC) websites, which are region specific. Highmark is in the process of redesigning and consolidating our PRC into a single site for all regions. Once that consolidation is complete, the sites above will be decommissioned and this website you are on (providers.highmark.com) will be your primary source for provider information from Highmark.

Newsletters for Professional and Facility Providers:

• Provider News
• Medical Policy Update

Additional Sources:

• News and Announcements via Highmark's Payer Spaces in Availity
• Special Bulletins
• Join Our Mailing List
• Provider Service Center

1.2 Highmark Websites

Highmark’s informational public websites cover all core business and subsidiary companies. They provide a broad range of information to customers, health care professionals, and the public.

To learn about Highmark’s history and access information about Highmark companies, subsidiaries, and affiliates, visit highmark.com. This website also provides you with information about Highmark’s community involvement, event sponsorships, and programs. In addition, you can learn about our Highmark Direct retail stores, access health and safety tips, and so much more. The public website for Highmark plans with service areas in Delaware, New York, Pennsylvania, and West Virginia can also be accessed from highmark.com.

Access to the Provider Resource Center is also available at highmark.com. Click on For Providers at the top of the screen.

The public website for Highmark Inc. service areas in Delaware, New York, Pennsylvania, and West Virginia is MyHighmark.com. This website provides information specific to individuals, members, employers, producers, and providers living in these locations. You can also access the Provider Resource Center from MyHighmark.com

When Highmark members have questions related to their coverage, your office may want to direct them to the appropriate public website for their service area. On each of these sites, members can find the following information and more:

Provider, Pharmacy, and Drug Information: By selecting the Find Doctor or Rx tab, members can access the Highmark Provider Directory and find information about participating doctors, hospitals, and other medical providers in their service area. In addition, this link allows them to search for participating pharmacies and also access drug formulary information.

Member Login: Members can register on this site for access to their secure account information. Once registered, members can log in to view their benefits and health and wellness information. They can also access their claim information and manage their health spending accounts.

Product Information: Individuals looking for insurance can learn about the Highmark products available in their service area by selecting the applicable tab: Individual & Family, Medicare, Employer, or Producer.

1.2 Highmark Provider Directory

The Highmark Provider Directory, located on each of our public websites, is a fast, easy way for our members to find providers near their homes or their workplace. And, it is a valuable tool that offers your current and potential patients important details about your practice, including office location, hours of operation, parking availability, and nearby public transit information.

The Centers for Medicare & Medicaid Services (CMS) requires Highmark to have the most current information on our network providers and also requires ongoing review of all physician information listed in the Provider Directory. The National Committee for Quality Assurance (NCQA) also requires the Provider Directory to include, and Highmark to confirm, the same physician information as for CMS, as well as the physician’s hospital affiliation. Hospital affiliation means the hospital(s) in Highmark’s networks where physicians have admitting or attending privileges.

Providers are required to review and update their information as soon as a change occurs. All data should be reviewed once a quarter, at a minimum, to ensure accuracy. If you determine that your information is inaccurate in the online directory, you can conveniently update the information online by accessing Provider Data Maintenance or Provider File Management (Delaware, Pennsylvania, and West Virginia only) through Availity.

Providers who do not verify or update their data in a timely manner will be removed from the Highmark Provider Directory. In addition, the provider’s status within Highmark’s networks may be impacted.

For providers in Delaware, Pennsylvania, and West Virginia: We encourage you to take advantage of one of the more unique features of our online directory — the ability to add your photograph. The inclusion of a photo helps to personalize your directory listing and can make it easier to market your practice to potential patients. Your photo can be easily uploaded through Provider File Management in Availity.

Providers acknowledge that the information listed in any Highmark Provider Directory, including, but not limited to, name, contact information, description of services, photographs, demographics, and other information, may also be listed in any Blue Cross Blue Shield Association (“BCBSA”) and/or other BCBSA independent licensee Plan provider directory(s), as determined by Highmark.

Please see Chapter 3, Unit 3: Professional Provider Guidelines for additional details of CMS requirements and on reporting changes.

1.2 Provider Resource Centers

The Provider Resource Center (PRC) is a repository of pertinent reference materials. This special section of our websites is specifically dedicated to providers and contains lots of helpful information and resources to assist in your daily interactions with Highmark members and with Highmark. We encourage you to bookmark the site and take advantage of this convenient reference resource.

The Provider Resource Center is available at highmark.com and MyHighmark.com. 

For your convenience, the Provider Resource Center is also available to you in Highmark's Payer Spaces in Availity. Additional information not accessible on the public websites is available in the Provider Resource Center via your secure Availity logon. 

1.2 Provider Newsletters

Highmark regularly releases publications as part of our commitment to keep the provider community informed. Some of the most important ways Highmark communicates with all providers is through our newsletters – Provider News and Medical Policy Update.

Provider News is a valuable resource for health care providers who participate in our networks. Published monthly on the last Monday of the month*, Provider News conveys important product, policy, and administrative information, including billing, claims, and program updates.

The publication also features the latest news, information, tips, and reminders about our products and services, as well as relevant interviews, articles, and stories, for health care professionals who serve Highmark members.

Regular topics include:

• New and Updated Reimbursement Policies
• Authorization Updates
• Staying Up to Date With the Highmark Provider Manual

*When a holiday falls on the last Monday of the month, Provider News will be published on the preceding Friday.

Current and past issues of Provider News are always available online on the Latest Updates page of the Provider Resource Center. 

Medical Policy Update is a monthly newsletter that provides information for most health care professionals and facilities participating in our networks. It focuses exclusively on upcoming medical policy and claims administration updates (including coding guidelines and procedure code revisions), and is the sole source for this information.

It is important for all participating providers and their office staffs to review each issue of Medical Policy Update. This publication serves as one of Highmark’s official notifications of new and revised policies and procedures. You can find current and past issues of Medical Policy Update on the Latest Updates page of the Provider Resource Center.

Distribution of all provider newsletters is primarily electronic. We publish all issues of the newsletters online in the Provider Resource Center on the Latest Updates page. Current and past issues of Provider News and Medical Policy Update are always available on the Provider Resource Center.

You may also sign up for electronic notification via email by clicking Join Our Mailing List in the top right corner of every page.

If you require a paper copy of the newsletter, please contact the Provider Service Center.

1.2  Special Bulletins

In addition to our regular publications, Highmark uses Special Bulletins to inform providers of changes to Highmark policies and procedures, updates to the formulary and authorization list, upcoming initiatives, etc. Special Bulletins are intended to be a companion to Highmark’s regularly scheduled periodicals.

Special Bulletins are used when we want to communicate information quickly, when the information is too complicated or lengthy to include in the newsletters, or when the information pertains to a limited group of providers or to a specific service area.

These communications from Highmark may be delivered to providers in any of the following formats:

• Online Communications
• Letters
• Brochures
• Fact Sheets
• Postcards
• Flyers included with checks and/or Explanation of Benefits

Because Special Bulletins contain important information about specific claims and coverage issues that could affect your practice, we hope you will take time to read them and retain them for future reference.

You can find current and past Special Bulletins on the Latest Updates page of the Provider Resource Center.

1.2 Join Our Mailing List

The Join Our Mailing List feature on the Provider Resource Center allows you to subscribe to electronic notification of various online publications and information updates. The latest Highmark news and updates arrive in your email inbox with timely, up-to-date information at your fingertips.

To subscribe to receive free email notifications with newly released publications or information updates, select Join Our Mailing List located in the top right corner of every page.

Enter the required information on the online form and select the applicable provider type – Professional Provider (837P & 1500 billers) and/or Facility/Institutional (837I & UB04 billers). Once you have completed the form, click on the Subscribe button at the bottom of the page. You will receive a confirmation message immediately when your subscription is successfully submitted.

The emails will be delivered to you from resourcecenter@email.highmark.com. To ensure delivery of the emails, please add the email address to your address book.

By subscribing, you agree to electronically receive administrative requirements that are legally binding upon contracted providers and upon Highmark. By doing this, you acknowledge that such communications and publications will be sent only by electronic means to the email address you provide. Please maintain such electronic publications in the event of future questions and to ensure such compliance. You may unsubscribe from this list at any time on future emails from Highmark.

1.2 Provider Service Center

Immediate answers to most inquiries can be found by using Availity^® - the preferred method for eligibility and benefit checks, prior authorization requests and inquiries, claims submission, and other transactions. For more complex issues or if Availity is unavailable, Provider Service Center representatives are available to answer questions and also provide information about Highmark programs.

Find the appropriate Provider Service Center for your region here.

When placing a call to Provider Service, please have all necessary information available including:

• Patient’s name, member ID, and group number;
• If available, the type of services and dates the services were performed;
• Claim number (taken from the Explanation of Benefits); and
• The provider’s name and provider number.

1.2 Contact Information

This section includes additional important telephone numbers, fax numbers, and other helpful contact information for all Highmark service areas.

A contact sheet is available at the top of every page through the CONTACT US link for easy access to a printable document with the most frequently used telephone numbers for contacting Highmark – the Provider Service Center and Highmark Clinical Services.

If you need assistance with an existing account and cannot log in to submit a ticket, or have started the registration process and are experiencing issues, you can call 800-AVAILITY (282-4548). 

For more information contact Availity.

Availity® is the preferred method for submitting authorization requests. Contact Highmark’s Clinical Services for precertification/authorization inquiries that cannot be handled via Availity. Please call the applicable number for your service area and/or provider type.

When Availity^® is not available and/or for medical management questions/issues that cannot be handled through Availity, Highmark's Behavioral Health Services can be reached by calling the applicable phone number for your service area.

To enroll in this free maternity education and support program, expectant mothers can call: 866-918-5267 

To verify eligibility and benefits for BlueCard^® members, please use one of the following options:

• Eligibility and Benefits Inquiry in Availity^®
• BlueCard eligibility telephone line: 800-676-BLUE (2583)
• HIPAA 270/271 electronic transaction

BlueCard^® participating physicians in other Blue Plan areas can be located by calling 800-810-BLUE (2583), or online at https://www.bcbs.com/.

For assistance or information about health care topics or support by a health coach, encourage your patients to call the Blues On Call phone line:

• 888-BLUE-428 (888-258-3428)
• This phone number is available on the back of applicable Member ID cards.

The Highmark Caring Program in Pennsylvania assists children with chronic conditions and/or special health care needs and their families to gain needed services by providing family-centered, community-based care coordination.

• For questions regarding care coordination, please call: 866-823-0892

The Highmark case management staff can be contacted by calling:

• Pennsylvania: 800-596-9443
• Delaware: 800-572-2872
• West Virginia: 800-344-5245; for Medicare Advantage 800-269-6389
• New York: 877-878-8785

If you received payments from more than one insurer and the combined payments exceed your claim charge, contact the Provider Service Center in your service area to speak to a representative.

Highmark utilizes ProView,™ the online credentialing system developed by the Council for Affordable Healthcare (CAQH), for credentialing and recredentialing.

• https://proview.caqh.org
• CAQH Help Desk: 888-599-1771 

If you would like to begin to submit claims electronically or need assistance with electronic claims submission, contact the Highmark EDI Operations support line by calling 800-992-0246.

Click on the applicable link to access the Highmark EDI Services website for your service area:

• Pennsylvania: https://edi.highmark.com/edi/index.shtml 
• Delaware: https://edi.highmark.com/edi-bcbsde/index.shtml 
• West Virginia: https://edi.highmark.com/edi-wv/index.shtml 
• New York: https://www.ask-edi.com/

Highmark partners with eviCore Healthcare (“eviCore”) for several care management programs. These include the following programs (may differ by Highmark region):

• Laboratory Management Program
• Musculoskeletal Surgery and Interventional Pain Management Services Prior Authorization Program
• Radiation Therapy Authorization Program
• Advanced Imaging and Cardiology Services Program

Although authorization requests for these programs can be submitted through the provider portal, there may be times when it is necessary to contact eviCore by phone at 888-564-5492.

Contact the Federal Employee Program (FEP) Provider Service Department by calling the applicable phone number for your service area:

• Pennsylvania: 866-763-3608
• Delaware: 800-721-8005
• West Virginia: 800-535-5266
• New York: 800-234-6008

Delaware, Pennsylvania, and West Virginia hours: 8:30 a.m. to 5 p.m. EST, Monday through Friday

New York hours: 8 a.m. to 5 p.m. EST, Monday through Friday

Note: Eligibility and benefits can be verified through Availity for FEP members residing in Delaware, New York, Pennsylvania, and West Virginia.

For claims that cannot be submitted electronically, they can be mailed to the appropriate claims address for the member's service area which can be found later in this unit under Mailing Addresses.

If you suspect fraud, contact your local Financial Investigations & Provider Review (FIPR) Department within Highmark.

Pennsylvania and Delaware:

• P.O. Box 890138 Camp Hill, PA 17001-9782
• Phone: 800-438-2478
• Fax: 717-635-4590

West Virginia:

• 614 Market Street P.O. Box 1948 Parkersburg, WV 26102
• Phone: 800-788-5661
• Fax: 717-635-4590

Highmark Blue Cross Blue Shield (WNY):

• P.O. Box 80 Buffalo, NY 14240-9984
• Phone: 800-333-8451
• Fax: 716-887-8591

Highmark Blue Shield (NENY):

• P.O. Box 15013 Albany, NY 12214-5569
• Phone: 800-314-0025
• Fax: 716-887-8591

Due to the nature of these investigations, every effort will be made to keep information confidential. Report suspected health care fraud anonymously via the above phone numbers or the Health Care Fraud Form.

For information on Health Options, Highmark Delaware’s managed care organization serving Delaware Medicaid recipients, please see the Health Options Provider Manual, which is accessible below on the website below. 

• Health Options Provider Services: 844-325-6252
• Authorizations: 844-325-6254
• Health Options website: http://www.highmarkhealthoptions.com/

MyCare Navigator is a telephone-based support service available to most Highmark members to help them make informed decisions and get the care that they need.

Highmark members and their families can reach a MyCare Navigator health advocate by calling the following toll-free telephone number:

• 888-BLUE-428 (888-258-3428)
• This phone number is available on the back of applicable Member ID cards. 

To obtain an NPI:

• Website https://nppes.cms.hhs.gov, or
• Phone: 800-465-3203 (TTY: 800-692-2326)

For spending account questions or issues in Pennsylvania and West Virginia, please call the dedicated Provider Spending Account Information Line at 800-652-9478.

For spending account questions or issues in Delaware, please contact Provider Service at 800-346-6262.

Pennsylvania and Delaware:

• Novitas Solutions, Inc.
• Website: www.novitas-solutions.com
• Medicare Part A & B Provider Inquiries: 877-235-8073 (TTY: 877-235-8051)
• Hours: 8 a.m. to 4 p.m. EST, Monday through Friday.

West Virginia:

• Palmetto GBA
• Website: www.palmettogba.com
• Medicare Part A & B Inquiries: 855-696-0705 (TDD: 866-830-3188)
• Hours: 8 a.m. to 4:30 p.m. EST, Monday through Friday.
  

If you have questions about Form 1099-MISC issues, please call 866-425-8275, or send via email to 1099inquiry@highmark.com.

1.2 Mailing Addresses

Electronic claims are convenient, confidential, and operational around the clock. Highmark’s claim processing system places a higher priority on claims filed electronically. And we offer options for HIPAA-approved claims submission via Availity and Highmark Electronic Data Interchange (EDI).

If you are not submitting claims electronically, use the tables below to determine the correct mailing address/addresses for your region.

Highmark Blue Cross Blue Shield (DE)

Highmark Blue Cross Blue Shield (WPA/NEPA)

Highmark Blue Cross Blue Shield (WNY) & Highmark Blue Shield (NENY)

Highmark Blue Cross Blue Shield (WV)

Highmark Blue Shield (CPA/SEPA)

If you are considering a move from paper claim submissions, please see the manual’s Chapter 1.3: Electronic Solutions — EDI & Availity and Chapter 6.2: Electronic Claim Submission.

IMPORTANT! Only original paper claim forms accepted. Highmark will accept and process only original red 1500/version 02/12 and UB-04 claim forms. Photocopies or outdated versions of the forms will be returned to the provider. The provider will need to resubmit the returned claims on the appropriate form.

Highmark utilizes the Optical Character Recognition (OCR) scanning system to assure accurate and efficient processing of paper claims. The OCR Scanner is programmed to read only the original red 02/12 version of the 1500 form and the original UB-04 institutional claim form.

Highmark provides recommended forms that providers may use when communicating with Highmark, Highmark members, or other providers in the network. The forms are readily available online on the Provider Resource Center; select Resources & Education from the main menu at the top of the page, and then Forms. 

If you require forms that are not available on the Provider Resource Center, forms may be ordered by writing to:

Highmark Shipping Control
P.O. Box 890089
Camp Hill, PA 17089-0089

Please include the form number and title, quantity, and shipping address.

To obtain a copy of Premier Blue Shield allowances for the most frequently reported codes for your specialty or a copy of your Highmark Blue Shield Usual, Customary, and Reasonable (UCR) profile, send a letter of request to:

Fee Based Pricing and Analysis
Highmark Blue Shield
P.O. Box 890089
Camp Hill, PA 17089-0089

Include your Highmark provider ID number, full name, address, and indicate whether you are requesting your UCR profile, Premier Blue Shield allowances, or both. This information is also available via Availity for those Availity-enabled offices.

These postal addresses are to be used solely for overpayments from:

• Health Savings Accounts (HSAs)
• Health Reimbursement Accounts (HRAs)
• Flexible Spending Accounts (FSAs)

1.2 Disclaimers

The following entities, which serve the noted regions, are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield. West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Health Insurance Company or Highmark Senior Solutions Company. Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield. Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield.

All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration and/or to one or more of its affiliated Blue companies.

All revisions to this Highmark Provider Manual (the “manual” or “Highmark Provider Manual”) are controlled electronically. All paper copies and screen prints are considered uncontrolled and should not be relied upon for any purpose.