Highmark of NENY Physical Therapy Auth Requirement to Begin
Starting April 1, 2024 Prior Authorization will be required for all commercial Highmark Blue Shield plans.
What does this mean for me?
For physical therapists that On Track Billing obtains authorizations for, no action is necessary at this time. If prior authorization is obtained in house, you will need the following:
Access to Availity
Familiarize self & relevant staff with the PredictalTM Auth Automation Hub and Helion Arc
Identify current or scheduled patients who are commercial Highmark Blue Shield members, and make note of new requirement in whatever way you currently track these needs (i.e. schedule, patient case, EMR tasks, etc.)
2. Will there be training?
Highmark will offer both live and on demand trainings. They are supposed to be posting training and information dates in their Provider Resource Center but there are currently none showing. They suggest checking periodically as we get closer to April 1st.
3. Where can I find more information?
Highmark’s Provider Resource Center, offers additional information and resources under the Procedures/Services Requiring Prior Authorization section. If you need assistance regarding electronic authorization workflows, you can email them at ElecAuthSubmit@highmark.com.
4. How can my staff and I easily identify these plans?
When in doubt, we always recommend confirming eligibility anyway, which can also be done through Availity, and that would list the plan type. There are also many helpful websites to search plan by prefix, such as https://bcbsprefix.com/
What On Track Billing can do to help:
Help you gain access and/or create users in Availity.
Provide you a list of patients who would fall in this category
Keep an eye out and update you on training slots
If we have access to your EMR system, we can place notes or reminders where you request.
We are putting together a prefix list for this plan so you can quickly and easily identify based off that.
