Bluecross Blueshield of Western New York Home

Medicaid HARP & CHP Providers

Welcome, providers!

Resources that help health care professionals do what they do best — care for our members.

At Highmark Blue Cross Blue Shield of Western New York (Highmark BCBSWNY), we value you as a provider in our network. That is why we have designed the provider site to make it more useful for you and easier to use.

Interested in joining our provider network? We look forward to working with you to provide quality services to our members.

Ensure our members are equipped to renew their Medicaid benefits

Help our members prepare to renew their Medicaid healthcare coverage and benefits by educating them on what documents are needed to ensure their renewal form is completed accurately. Members can get assistance with their renewal via our retention call center at 844-885-1004 (TTY 711), through the NY State of Health website or calling 855-355-5777.

If you have questions about eligibility, benefits, authorizations, claims status, and more, log in to Availity Essentials* and select Chat with Payer. For additional support, please use the following resources or contact us if more clarification is needed.

Attention providers!

At the end of 2022, Office of the Medicaid Inspector General (OMIG) issued final regulations that repeal and add a new New York Codes, Rules, and Regulations (NYCRR) amendment to implement changes to:

  • Provider compliance programs
  • Medicaid Managed Care plan fraud, waste and abuse (FWA) prevention programs under the Medicaid program
  • The obligation to report, return and explain Medicaid overpayments through OMIG’s Self-Disclosure Program

This amendment took effect on December 28, 2022, with enforcement of the requirements beginning March 28, 2023.

To participate in and receive payment from the Medicaid program, providers must:

  • Certify to maintaining an effective compliance program that meets the requirements issued by OMIG as part of their annual Certification Statement for Provider Billing Medicaid (ETIN) form 
  • Submit a copy of their Certification Statement for Provider Billing Medicaid (ETIN) form to each Managed Care Plan (MMCO) for which they are a participating provider with the MMCO and each year after

A copy of your certification/ETIN form may be submitted to our health plan, via e-mail to WNY_PR_Compliance_Program_Certification@amerigroup.com.

For more detailed information, please visit the Compliance page of the New York State Office of the Medicaid Inspector General

COVID-19 information

Highmark BCBSWNY is closely monitoring COVID-19 developments and how the novel coronavirus will impact our customers and provider partners.

Availity access

The Availity Portal offers health care professionals free access to real-time information and instant responses in a consistent format regardless of the payer.

At Availity, you can:

Request authorizations
Submit claims
Confirm eligibility

Log in to Availity

Learning opportunities

Find learning opportunities to assist with administering your patient’s health plan using Availity Essentials multi-payer features and payer spaces applications. Use the library of self-paced courses and instructor-led training sessions, available 24/7 at no cost. Be prepared with the knowledge to assist our members.

Don’t have an Availity account?

Receive email from Highmark BCBSWNY

Highmark BCBSWNY is now sending some bulletins, policy change notifications, prior authorization update information, educational opportunities and more to providers via email.

Provider News

Get the latest articles and announcements on claims filings, products, benefits, administrative updates, new and revised procedures and guidelines, prescription information, and more.

 

Featured resources

Pharmacy Information

Search for up-to-date drug information, including hundreds of brand-name and generic medications.

Maternal child program

When it comes to our pregnant members, we are committed to keeping both mom and baby healthy. We encourage all our moms-to-be to take part in the New Baby, New LifeSM program, a comprehensive, proactive case management and care coordination program for all expectant mothers and their newborns.

Behavioral health provider

We work collaboratively with hospitals, group practices and independent behavioral health care providers, community and government agencies, human service districts, and other resources to meet the needs of members with mental health, substance use, and intellectual and developmental disabilities.

Provider tools and resources

Interested in becoming a provider in the Highmark BCBSWNY network?

We look forward to working with you to provide quality service for our members.