A newsletter for Highmark Blue Cross Blue Shield providers in West Virginia
Issue 6, June 2024
With Highmark Health Options West Virginia (HHO WV), Medicaid beneficiaries in the Mountain state will have another option for their health care, effective July 1, 2024. Highmark Health Options West Virginia is the first Blue Cross Blue Shield managed care organization (MCO) to be approved by the West Virginia Department of Human Services, Bureau for Medical Services. For more information, click here
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On Jan. 1, 2025, Highmark will launch its High Performing Provider (HPP) Program for practitioners who provide outpatient physical therapy and occupational therapy services. The HPP Program allows greater self-management for providers who meet certain performance metrics. To learn more, go here.
Prior authorization is required for outpatient physical medicine services. When requesting prior authorization for these services via the Predictal™ Auth Automation Hub in Availity®, providers must select “Physical Medicine” as a Sub-Service Type. For step-by-step instructions, click here.
The 28th edition of MCG’s Care Guidelines will be available on Aug. 1, 2024.
After that date, you will be able to submit authorization requests using the 28th edition for any new requests. Any authorization requests with a start of care date prior to Aug. 1, 2024, will be reviewed using the 27th edition.
Please continue to use the Predictal Auth Automation Hub application in Availity® to submit authorization requests with clinical information included.
Effective July 1, 2024, Highmark will transition from the American Society of Addiction Medicine (ASAM) Criteria 3rd Edition to the ASAM Criteria 4th Edition. Highmark uses ASAM criteria to review authorization requests for substance abuse services.
To learn more about the ASAM Criteria 4th Edition, go here.
