Bluecross Blueshield of Western New York Home

Medicaid & CHP Providers

Provider resources overview

We are committed to supporting you in providing quality care and services to the members in our network. Here, you will find frequently used forms, PDFs, provider manuals and guides, prior authorization information, practice policies, and support for delivering benefits to our members.

Provider forms

Provider forms are located in our online library for easy access.

Training academy

Highmark Blue Cross Blue Shield of Western New York (Highmark BCBSWNY) offers training and tutorials to support providers in continuing their education. We will add additional training documentation as they become available.

Provider manuals and guides

Highmark BCBSWNY provider manuals and guides provide key administrative information, including the quality improvement program, the utilization management program, quality standards for participation, claims appeals, reimbursement and administration policies.

Learn about Availity

Many of the tools you need — such as eligibility and benefits inquiry, claims submission, claims status inquiry, and authorizations — can now be accessed by logging into your account on the Availity Portal.

Precertifications

Highmark BCBSWNY makes determinations based on selected inpatient or outpatient medical services including surgeries, major diagnostic procedures and referrals to validate medical necessity.

Additional information

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Behavioral health

The Highmark BCBSWNY behavioral health provider network includes psychiatrists, psychologists, social workers, psychiatric nurses, and other mental health and employee assistance health care professionals. Our facility network includes hospital inpatient units, residential treatment centers, partial hospitalization programs and intensive outpatient services and programs.

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.