The latest articles and announcements on claims filings, products, benefits, administrative updates, new and revised procedures and guidelines, prescription information, and more.
Pharmacy Billing Guidance (Exceptions for Non-Enrolled Prescribers)
Updates to Pharmacy Billing Guidance for Interns, Residents and Foreign Physicians in training as well as Out-of-State (OOS) Licensed Prescribers who are treating Medicaid Members for a single instance of emergency care within 180 days.
Policy Clarification for Practitioner Dispensing
New York State Education (NYSED) Law, Article 137 §6807, authorizes practitioners, who are authorized to prescribe, to dispense medications directly to their patients. This dispensing must be done in accordance with federal, State, and New York State (NYS) Medicaid program policies for dispensing, billing, and record keeping.
Annual Primary Care Provider Audit
Quality Management department is conducting an annual medical record review for documentation standards specific to the MMC and CHPlus programs only.
9/1/22 Medicaid Enrollment Requirement Notice
Effective September 1, 2022, Highmark Blue Cross Blue Shield of Western New York members must use providers (e.g., pharmacies, providers, and specialists) enrolled with the NYS Medicaid program.
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