• General News
• Self-Service Tools Now Required for Routine Claim Inquiries
• The Transition to a New Provider Portal
• August is National Immunization Awareness Month
• Short Takes: Diversity Survey, Stabilize and Transfer Protocol, and More
• New Clinical Support Program Resource Page
• DELAYED: Pharmacy Authorization Submissions Moving to New Auth Automation Hub
• Reimbursement, Claims & Billing
• Correction: Reimbursement Changes to Incident To Services
• Reimbursement Updates, Including Changes to RP-026
• Authorization Updates
• Administrative News
• Quarterly Formulary Updates
• Ensure Your Directory Information Stays Current
• Staying Up to Date With the Highmark Provider Manual

Chapter 4, Unit 1: PCPs and Specialists

• The 4.1 PCP And Medical Specialist Accessibility Expectations section was updated under ACCESSIBILITY EXPECTATIONS FOR PROVIDERS. For Urgent Care Appointments, the Performance Standard was changed from “Office visit within 1 day (24 hours)” to “Immediate response” in the PCP AND MEDICAL SPECIALIST ACCESSIBILITY EXPECTATIONS table.

Chapter 5, Unit 1: Care Management Overview

• In the 5.1 Introduction to Care Management section, “Wellness” replaced “Health Promotion (except in New York)” in a bulleted list of core services.
• In the 5.1 High-Risk Maternity (NY Only) section:
• Under BENEFITS FOR PHYSICIANS, MOTHERS, AND THEIR BABIES, a link to the Preventive Health Guidelines page of the Provider Resource Center was added. There, the High-Risk Maternity clinical practice guidelines are included in the Prenatal/Perinatal Care Preventive Health Guidelines.
• Under POSTPARTUM VISIT COMPONENTS, links for supporting documentation were updated.
• In the 5.1 Practice Guidelines and Standards of Care for HIV (NY Only) section:
• Under AIDS INSTITUTE NYSDOH COUNSELING AND TESTING RESOURCES, the phone number for HIV Counseling was updated.
• Under PREGNANT WOMEN AND EXPOSED INFANTS LOST-TO-CARE REQUIRE IMMEDIATE ACTION FOR RE-ENGAGEMENT, the phone number for the New York State Department of Health Perinatal HIV Prevention Program was updated.

Chapter 5, Unit 2: Authorizations

• In the 5.2 Authorization Request Process section:
• Under HOME HEALTH AUTHORIZATION REQUESTS, the language was updated to reflect that authorization procedures for Delaware, Pennsylvania, and West Virginia are the same for each region. Previous language gave the appearance that there were different regional procedures.
• Under TELEPHONE REQUESTS, the contact information was updated. Professional providers should use the phone numbers for the appropriate Medicare Advantage program.

Chapter 5, Unit 6: Quality Management

• In the 5.6 Functional Areas and Their Responsibilities section, the committee list under QI Committee Structure (for providers in New York) was updated to include Highmark Inc./Highmark NY Utilization Management Master Service Agreement (MSA) Joint Oversight, and Network Quality and Credentials Committee.
• In the 5.6 Case Review Process for Quality Concerns section, language under IMPORTANT! (for providers in New York) was updated to: “Members are able to make clinical quality of care complaints to the health plan.”
• In the 5.6 Clinical Quality section under CONDITION MANAGEMENT PROGRAM, HIV/AIDS was added to the list of chronic conditions for which members are eligible to receive health coaching.