A newsletter for Highmark Blue Cross Blue Shield providers in West Virginia
Issue 8, August 2024
It is important to file a corrected claim accurately to ensure that Highmark can identify the original claim, understand the correction that is required, and ensure that the corrected claim is not denied as a duplicate.
To reduce errors and possible rejection of your claim resubmission, please follow the guidelines listed in this Special Bulletin
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Effective Nov. 15, 2024, all appeals of Credentials Committee decisions for Delaware (DE) and West Virginia (WV) professional providers will be presented to the Highmark Network Quality and Credentials Committee (NQCC). Appeals will no longer be presented to the Appeals Review Committee (ARC). The reconsideration step is being removed. To learn more, click here.
NIAM is an excellent time for not only communicating the importance of routine vaccinations, but also for reviewing... Click here to read more.
Throughout August, the independent research firm Press Ganey will conduct phone surveys with a sampling of providers in Delaware, New York, Pennsylvania, and West Virginia. Survey questions will assess knowledge of the tools available to you and your staff and to verify the products/networks in which you participate through your Highmark contract. To learn more, click here.
Effective Aug. 19, 2024, Express Scripts Pharmacy is no longer stocking a limited set of medications for all lines of business. Members currently receiving impacted drugs have the option to fill an alternative drug at Express Script home delivery, but those who want to or need to continue filling the impacted drugs will need to do so from an alternative, in-network retail pharmacy. For more information and to see the list of impacted medications, click here.
As of Aug. 1, 2024, Highmark has added Farxiga to its Medicare formularies as a Tier 3 Preferred Brand Name Drug. This change will help to reduce prescription drug costs for our members. To read the Special Bulletin, go here.
