Short Takes: Electronic Auths, COVID-19 Boosters, and More

New COVID-19 Booster Vaccines Added to the Preventive Schedule

The Centers for Disease Control and Prevention (CDC) has recently approved new, single-dose COVID-19 booster vaccines from Pfizer, Moderna, and Novavax to protect against the XBB variant. The Pfizer and Moderna boosters are for all persons 6 months and older; the Novavax vaccine is for individuals 12 and older. For more information, click here.


EDI Update: Highmark Accepting 275 Attachments

Highmark is now accepting 275 attachments from facilities and providers who are responding to a request for additional documentation. Providers should submit 275 transactions through their trading partners via Electronic Data Interchange (EDI). To learn more, click to read the Special Bulletin.


UPDATE: RSV Vaccine Now Approved for Pregnant Women

The Centers for Disease Control and Prevention (CDC) has approved respiratory syncytial virus (RSV) vaccines for infants, pregnant women, and adults 60 years of age and older. These vaccines are being retroactively added to the Highmark Preventive Schedules. Click hereto read the updated Special Bulletin.


Providers Encouraged to Submit Electronic Authorizations, Forms to be Removed

In anticipation of an upcoming change in West Virginia Law (Senate Bill 267*), Highmark is encouraging all providers to submit prior authorization requests electronically using our provider portal (either Availity® or NaviNet®). Submitting electronically allows for faster reviews and greater transparency around the status of authorization requests.

On December 1, 2023, Highmark will remove prior authorization forms from the West Virginia Provider Resource Center (PRC). The removal of the forms will not impact a provider’s ability to submit a prior authorization request by phone or fax. However, beginning July 1, 2024, all authorization requests will need to be submitted via our provider portal β€” which is a requirement of West Virginia SB 267*.

*West Virginia Senate Bill 267 requires prior authorizations to be submitted via an electronic portal. For more information on the bill, visit https://www.wvlegislature.gov.

To read the Special Bulletin, click here.


FEP Claims Will Be Reviewed by Clinical Editing Tool Starting December 1, 2023

To align with our internal claim review process, Highmark will start using a clinical editing tool to analyze Federal Employee Program (FEP) claims, effective December 1, 2023. Clinical editing is an effective and efficient method for quickly reviewing and approving correct claims, while also identifying errors on incorrectly coded claims during the prepayment process. To learn more, click here.


Error Corrected: Medical Policy S-248 Nerve Ablation and Injection

There was a typing error in the September 4, 2023, published version of S-248 Nerve Ablation and Injection. The Genicular Nerve Block section of the policy was inadvertently placed into the Genicular Nerve Radiofrequency Ablation section. The policy has been corrected and published on September 27, 2023.


Medical Policy Update Newsletter

The October newsletter is available here.

 

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