A newsletter for the Highmark Blue Shield providers in central Pennsylvania, the Lehigh Valley, northeastern Pennsylvania and southeastern Pennsylvania
Issue 9, September 2023
New and Updated Reimbursement PoliciesHighmark regularly issues new or updated reimbursement policies. Keep an eye on this newsletter and the Provider Resource Center (PRC) homepage for announcements regarding upcoming policy changes. As specific policy changes go into effect, the updated policies can be found on the Reimbursement Policy page of the PRC.
Below is a list of recent and upcoming updates to Reimbursement Policies (RPs):
RP-010 Incident To Billing Services
For Pennsylvania: Incident To services for Commercial products will no longer be recognized, effective January 1, 2024. Consistent with the Centers for Medicare and Medicaid Services (CMS), for Medicare Advantage products, Highmark will continue to recognize and reimburse for Incident To services rendered by Mid-Level Practitioners (MLPs) and Advanced Practice Providers (APPs) who have been enumerated and bill using their own Provider ID.*
*Direction for continued reimbursement for MLPs and APPs was published in a new policy, RP-068 (see NEW: RP-068 further down in this article), effective on September 25, 2023.
RP-019N Drugs and Biologicals
An updated version of this policy was published to the PRC on August 31, 2023, and went into effect on September 1, 2023. Drug tiering is being eliminated for Delaware, Pennsylvania, and West Virginia. To access this reimbursement policy, log into NaviNet® and select Resource Center from the left menu. Once redirected to the PRC, select CLAIMS, PAYMENT & REIMBURSEMENT in the left menu and then click Reimbursement Policy.
RP-006 Multiple Endoscopy Procedures
This policy was reviewed as part of our standard review process. No changes in direction were made.
RP-001 Assistant at Surgery Services
A modifier definition section was added. No changes in direction were made.
RP-019N Drugs and Biologicals
An additional information section was added, as was direction on frequency of fee updates. To access this reimbursement policy, log into NaviNet® and select Resource Center from the left menu. Once redirected to the PRC, select CLAIMS, PAYMENT & REIMBURSEMENT in the left menu and then click Reimbursement Policy.
NEW: RP-068 Mid-Level Practitioners and Advanced Practice Providers
Highmark has created RP-068 to provide direction on reimbursement for Mid-Level Practitioners and Advanced Practice Providers.
RP-026 Portable Radiography and ECG Services – Modifiers UN, UP, UQ, UR, US
This policy will be made applicable to Medicare Advantage. Additional direction will be added for modifiers UN, UP, UQ, UR, and US when submitted with code R0075 (a transportation service code). These modifiers are also required to be included on all related claims, and the Commercial section will be updated with direction to reflect this requirement.
