Our case manager helps make health care easier and less overwhelming for patients. They work with our members to help them understand the types of services we offer to them and how to participate in their own care.
Your patients may already be working with one of our care managers. If not, or if they need help contacting their care manager, please have them call Member Services .
Our care managers may call a patient if:
- They or you, their health care provider, thinks care management might help the patient.
- They have just gotten out of the hospital and need help with follow-up visits to other doctors.
- They are going to the emergency room (ER) often for non-urgent care that could be handled by you, their health care provider.
- They call our 24/7 NurseLine and need more follow-up for ongoing care.
- They have serious physical problems and need more help managing their health.
- They have behavioral health problems and need more help working with all of their doctors.
Care managers can also help with:
- Setting up health care services for the patient.
- Getting referrals and prior authorizations.
- Checking a patient’s plan of care.
From time to time, patients may have questions about calls they receive from one of our care managers, licensed clinicians, or outreach care specialists. When we call, a nurse or social worker will:
- Always identify themselves with their name, title and position with Highmark Blue Cross Blue Shield of Western New York.
- Tell the patient about the services we offer.
- Talk to the patient about their health and how they’re handling different parts of their life.
Provider tools and resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Precertification lookup tool
- Precertification requirements
- Claims overview
- Member eligibility & pharmacy overview
- Provider manual and guides
- Training Academy
- Pharmacy information
- Electronic Data Interchange (EDI)