Welcome, providers!

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: certification requirement

Highmark Blue Cross Blue Shield (Highmark BCBS) partners with Wellpoint companies to administer certain services to Medicaid Managed Care (MMC), Health and Recovery Plan (HARP), and Child Health Plus (CHPlus) members. Please note, this information is specific to the MMC, HARP, and CHPlus programs only.

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

• Care provider compliance programs.
• MMC fraud, waste, and abuse (FWA) prevention programs. 
• 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 program, care 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 form for the purposes of obtaining an Electronic/Paper Transmitter Identification Number (Certification Statement for Provider Billing Medicaid [ETIN]).
• 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.

For detailed information on the certification requirement and the care providers affected, visit the Compliance page of the OMIG.

The submission can be streamlined for participating providers by utilizing the Digital Post Office (DPO) feature on Availity.com . Do note that DPO is only available for annual certification for providers who are billing Medicaid submissions and is only available for care providers with a registered NPI. Use the following process for DPO:

• Log in to your Availity.com and select the Highmark BCBS Medicaid and Child Health Plus payer space. Then, select DPO. This will navigate to a digital drop box:
  • In the organization drop down box, select Highmark BCBS, enter the TIN, and select the care provider you are submitting the certification for. Select Next to be directed to the submission dashboard.
  • Select the blue box named New Submission, which directs you to the package page.
  • Your submission type will default to Provider Certification. Select Next to be directed to the document upload page.
  • The submission type drop down will default to Annual Certification Statement for Provider Billing Medicaid. Select the submission year and select Step 2 to upload the certification documentation. Select Review and Submit and attest the information is accurate and truthful. You will be directed to the Review page to submit.
  • Once you are ready, select Submit. The confirmation page will provide a tracking number, package information, and date of submission for your records.

If you are unable to use Availity.com or prefer to submit via e-mail, a copy of the certification form can be emailed to WNY_PR_Compliance_Program_Certification@wellpoint.com.

COVID-19 information

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