Highmark West Virginia Relinquished Washington County, Ohio, Service Area
Highmark Blue Cross Blue Shield in West Virginia relinquished the Washington County, Ohio, service area. The change — which was requested by Highmark — was approved by the Blue Cross Blue Shield Association in November 2023. As a result of this relinquishment, Anthem Blue Cross Blue Shield is the only local Blue Plan in Washington County, Ohio, and effective Oct. 22, 2024, the Highmark systems will no longer recognize Washington County, Ohio, as part of the Highmark service area.

We are working with Anthem to ensure a smooth transition for all affected providers and members.

What Providers Need to Know

Do You Practice in Washington County, Ohio?

If your practice and/or facility is located in Washington County, Ohio, you may be dually contracted with Highmark and Anthem and currently submit claims to Highmark or Anthem for non-Highmark or non-Anthem Blue Plan members. Effective Oct. 22, 2024, you may only submit claims to Highmark for Highmark members as a contiguous county claim and you may not submit claims to Highmark for any other Blue Plan member. Please see the information below on contiguous county claims filing.

Question: I’m already contracted with Highmark and I have offices in both West Virginia and Washington County, Ohio. Do I need to be contracted with Anthem?

Yes. If you have an office in Washington County, Ohio, you should also be contracted with Anthem if you want to service Anthem members on a participating/in-network basis. If you do not have a contract with Anthem, you will be out of network for Anthem members and all other Blue Plan members. The vast majority of providers who have offices in both West Virginia and Washington County, Ohio, are dually contracted with Highmark and Anthem. If you’re not one of those providers, contact Anthem today by going here or calling 800-676-BLUE (2583) to begin the credentialing process.

Contiguous County Claims – How They Work

Highmark contracts with providers located in counties in other Blue Plan service areas that border our service areas. These Highmark contiguous county provider contracts — for Commercial and Medicare Advantage lines of business — apply only to Highmark members who work or reside in the Highmark service area.

Claims filing rules for contiguous area providers are based on the following:

  • Provider’s physical location (the Blue Plan service area where the provider’s office is located).
  • Provider’s contract status with the two Blue Plans (Is the provider contracted with only one or both service areas?).
  • Member’s Home Plan and where the member works and resides.
  • Location where the member received services.

Criteria for Submitting to the Member’s Home Plan

Contiguous county claims filing rules allow claims to be filed directly to the member’s Home Plan when each of the following criteria are met:

  • The Home Plan’s member lives or works in the Home Plan’s service area, and
  • The Home Plan contracts with a provider located in its contiguous county, and
  • Service is provided in the provider’s office located in a contiguous county.

If each of the criteria are not met, the claim must be filed to the Blue Plan in whose service area the provider is located.

IMPORTANT: Effective Oct. 22, 2024, if a Highmark member works or resides in any Highmark service area and receives services from a Highmark-contracted provider located in Washington County, Ohio, the provider must submit the claim to Highmark West Virginia. However, if a Highmark member who does not work or reside in a Highmark service area receives services from a Highmark-contracted provider located in Washington County, Ohio, the provider must submit the claim to Anthem.

Background

Highmark Health acquired the Washington County, Ohio, portion of the service area through the former Primary Licensee Highmark Inc.’s affiliation with Mountain State Blue Cross Blue Shield. Post-affiliation, that company eventually became what is now known as Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield.

Highmark West Virginia has not actively marketed the Blue brands in Washington County, Ohio, since Mountain State was renamed and assumed the trade name Highmark Blue Cross Blue Shield West Virginia in 2011.


 

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