IN THIS ISSUE:

Staying Up to Date With the Highmark Provider Manual

Ensure you are regularly reviewing the Highmark Provider Manual for our most recent guidance on:

Some recent noteworthy changes include:

Chapter 4, Unit 2: Behavioral Health Providers & Chapter 5, Unit 4: Behavioral Health – The contact information for Highmark Behavioral Health (BH) Services was updated to include a fax number for Delaware, Pennsylvania, and West Virginia. In addition, Highmark BH Services no longer offers Sunday hours of operations.
Chapter 5, Unit 1: Care Management Overview – The High-Risk Maternity (NY Only) section was updated to include additional guidance under “Interventions for High-Risk Patients.”
Chapter 6, Unit 1: General Claim Submission Guidelines – The Additional Diagnostic Code Reporting (NY Only) section was updated under “Sleep Studies” to include a qualifying statement for Chemotherapy, Transfusion, Cast Room, Infusion Therapy, and Treatment Room that the service could pay up to $50 per day for a room charge. This qualifying statement was in the Highmark Provider Manual on the HealthNow provider websites but was inadvertently omitted when transitioned to the Highmark Provider Resource Center websites.
Chapter 6, Unit 2: Electronic Claim Submission – The Submitting Claims (NY Only) section was updated under “Claim Adjustment Policy.” The policy for New York was corrected to reflect that providers have 365 days, rather than 180 days, to file a claim adjustment request.

To see the full list of recent changes, visit the Highmark Provider Manual Changes page.