A newsletter for Highmark Blue Cross Blue Shield providers in West Virginia
Issue 2, February 2024
Facility providers should submit a reconsideration request for denied admissions for Commercial inpatient medical care due to a lack of clinical information on the original authorization submission. NOTE: Reconsideration requests only apply to Commercial lines of business. To read the Special Bulletin, click here
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The 2024 Healthcare Effectiveness Data and Information Set (HEDIS®) includes changes to the following measurements:
To learn more about the changes, click here.
Effective March 1, 2024, Alliance Rx Walgreens Pharmacy is being added as an exclusive specialty pharmacy for members in Highmark’s Hemophilia and Bleeding Disorder Drug Program. The other two pharmacies in the program are Soleo Health and the Hemophilia Treatment Center of Western Pennsylvania. Option Care Health will no longer be participating in the program effective March 1, 2024.
In addition, the following three drugs will be available through the program on March 1, 2024:
To learn more, click here.
The publication of Medical Policy (MP) S-123 Lung and Lobar Lung Transplant was delayed. Originally scheduled for Jan. 15, 2024, the policy was published on Jan. 22, 2024. To view MP S-123, go to the Provider Resource Center. On the top task bar, click the drop-down arrow for MEDICAL POLICY SEARCH, select MEDICAL POLICIES, and then type “S-123” into the search bar.
