Urgent: WNY and Northeaster NY Highmark Prior Authorization
As previously reported, Highmark is planning to implement a prior authorization program for chiropractic care, physical and occupational therapy, and home health care effective on April May 1, 2024. Highmark recently updated their provider news to announce "For Highmark Blue Cross Blue Shield members in commercial plans, providers will need to request authorization for outpatient physical medicine and home health services, effective April May 1, 2024."
Although it is unclear whether Highmark WNY provided this notice directly to its contracted providers, additional information regarding the program is now available on Highmark WNY's provider portal at the following links:
- https://hwnybcbs.highmarkprc.com/pnews/pn-2-2024/pt_ot_chiro_and_home_health_prior_auth_changes_occurring_on_april_1_2024.html
- https://hwnybcbs.highmarkprc.com/Care-Management-Programs/Physical-Medicine-Management-Program
PLEASE NOTE: Highmark is offering live training to help prepare you for these upcoming changes both today (Mar 12, 2024) and next Monday (Mar 18, 2024) at 1pm. You must register to attend. To register, simply access the web page above, scroll down to the Training section, select the date you wish to attend, and complete the registration. We received confirmation, a link to the webinar and a passcode within several minutes of registration.
Register: Mar 12, 2024 01:00 PM ET
Register: Mar 18, 2024 01:00 PM ET
There is also an instructional video available which reviews the steps to submit a prior authorization via Availity. That video is available at the following link: https://vimeo.com/901235700/b5afa9261b?share=copy
The NYSCA is concerned that our members seem to have little knowledge of the details of this program, and only a short timeframe to consider how the new prior authorization program will impact their practice and care of their patients. We are seeking additional information and will report back accordingly. In the meantime, we encourage you to review the above information and share any information you might have with the NYSCA so we may share it with other members.
