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.
The Availity Portal offers health care professionals free access to real-time information and instant responses in a consistent format regardless of the payer.
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.
Highmark BCBSWNY is now sending some bulletins, policy change notifications, prior authorization update information, educational opportunities and more to providers via email.
The latest articles and announcements on claims filings, products, benefits, administrative updates, new and revised procedures and guidelines, prescription information, and more.
Beginning April 1, 2023, all Medicaid members enrolled in Highmark Blue Cross Blue Shield of Western New York (Highmark BCBSWNY) will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program. Information about the transition of the pharmacy benefit from Highmark BCBSWNY to NYRx, the Medicaid Pharmacy Program can be found HERE. General information about NYRx, the Medicaid Pharmacy Program can be found HERE along with information for Members and Providers
Highmark Blue Cross Blue Shield of Western New York (Highmark BCBSWNY) partners with Amerigroup companies to administer certain services to Medicaid Managed Care (MMC) and Child Health Plus (CHPlus) members. Please note, this information is specific to the MMC and CHPlus programs only.
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.
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.
Quality Management department is conducting an annual medical record review for documentation standards specific to the MMC and CHPlus programs only.
Rate Our Performance. This information would assist the Network Relations Department in areas of success and improvement.
Search for up-to-date drug information, including hundreds of brand-name and generic medications.
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.
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.
