If you need help ling a grievance, understanding the grievance process, or need help getting information for us to review, please contact Member Services at 1-844-325-6251 and ask for a Member Advocate. Highmark Blue Cross Blue Shield West Virginia For TDD/TTY services, please call 1-800-480-1419. If you, or someone you choose, are unhappy with the State Fair Hearing decision, you or your representative can ask for a judicial review in Superior Court. All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. To file an appeal, you can call Member Services and they will help you file your appeal. Please reference the: HIGHMARK PROVIDER MANUAL: Chapter 3, Unit 2: Professional Provider Credentialingfor additional information related to the credentialing process and requirements. Dental Providers. If you are a Highmark health plan member with questions about your coverage, call the Member Service phone number on the back of your insurance card. 8) What is Highmark Delaware's Holiday Schedule? If you would like a paper Updated quarterly, this document lists codes and prior authorization requirements for medical procedures and services. If we agree that you should get an appeal decision faster, you will receive a decision within 72 hours after Highmark Health Options receives your request.. The letter will also tell you what you need to know to get ready for the hearing. Call Provider Services at 1-844-325-6251, Monday through Friday, 8 a.m. 5 p.m., or contact your Provider Account Liaison. Updated quarterly, this document lists codes and prior authorization requirements for medical procedures and services. PO Box 106004 For questions about our company or website, use the mailing address provided or fill out the form below. We may also extend the timeframe for decision up to 14 days if additional information is necessary and the delay is in your best interest. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. NaviNet-enabled providers are expected to use this tool for all routine eligibility, benefits and claim status inquiries. For more information, call Provider Services at 1-844-325-6251 MondayFriday, 8 a.m.5 p.m. picture_as_pdf Fee Schedule and Procedure Codes You will get a letter from us within five working days after your appeal. SHOP. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Monday - Friday: 8:00 a.m. - 7:00 p.m. Saturday & Sunday: Closed. (TTY/TDD: 711). 2) How do I begin using EDI to submit claims electronically? NaviNet can also be used to submit authorization requests, recredentialing applications, and provider information changes. Our network providers and other health care professionals are our partners in the delivery of high-quality health care services to our members. Medical Director, c/o Manager of Operational QI Highmark Blue Cross Blue Shield West Virginia P.O. You can have someone file an appeal for you or represent you. UCD Member FAQs. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Read the latest faxed communications to Highmark Health Options providers. Provider Directory. 7) Can you explain the credentialing process? This letter will tell you the reason for our decision and further appeal rights including your right to ask for a State Fair Hearing (see What should I do to get a State Fair Hearing below). 1099 Misc For Central, Eastern, and Western Region Providers: If you have any questions about form 1099 Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Convenient self-service prompts are available. Mailing Phone: (304) 347-7681. Answer your questions about the appeal or grievance process. 5) How do I contact NaviNet with technical issues? This may include exploring ways to improve health care delivery, clinical quality, cost-effectiveness of services, communication and cooperation. Hours of operation are 8:00 a.m. to 4:30 p.m. EST Back to Top How can I reach Customer Service by U.S. To do this, you must le with the clerk (Prothonotary) of the Superior Court within 30 days of the date of the State Fair. 2022 Highmark Health Options. At least three members will be selected from nominations submitted by the West Virginia State Medical Association. Online contacts Provider Relations - provrel@highmarkbcbsde.com, Phone Numbers To confirm eligibility - 800.342.2221, Mental Health/Substance abuse - 800.421.4577. all member appeals or grievances to 1-833-841-8075. Forgot username or password? Provider Contact. Fifth Avenue Place Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. These are members of the Diamond State Health Plan (DSHP), Delaware Healthy Children Program (DHCP), and DSHP Plus Long-term Services and Supports. Providers Do not use this mailing address or form A State Fair Hearing is an appeal process provided by the State of Delaware. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Select Language; Select Language Please note that if your representative or doctor files an appeal for you, you cannot le a separate appeal on your own. A grievance can be about any service that you received from a doctor or by us. 2022 Highmark Health Options. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. Clinical Provider Appeals are cases that are denied due to lack of prior authorization or denied based on medical necessity. A decision will be made within 30 days after we receive your grievance. Those matters are handled as appeals (see Appeals below). We have failed to give you timely service. The time period or service limits you were previously authorized for has been met. Contact Us Box 22278 Highmark is a registered mark of Highmark Inc. {currentyear} Highmark Inc., All Rights Reserved. Not a Highmark member? Request a Call to talk to a Highmark licensed representative about our non-Medicare plans or to enroll. Not a Highmark member? Call 1-866-488-7469 TTY: 711 (Monday - Sunday 8:00am to 8:00pm EST) to talk to a representative who can answer questions about our plans. The contents of this list are subject to change in accordance with plan policies and procedures and the Provider Manual. If you need help ling an appeal, understanding the appeal process, or help getting information for us to review, contact Member services at 1-844-325-6251 and ask for a Member Advocate. Pittsburgh, PA 15222, 800 Delaware Avenue, Wilmington, DE 19801. You, your representative, or doctor can request a fast appeal orally or in writing. Medicaid: 1-800-392-1147 8am to 8pm, Monday through Friday Medicare: 1-800-685-5209 October 1 through March 31: 8 am to 8 pm, 7 days a week April 1 through September 30: 8 am to 8 pm, Monday through Friday (TTY# 711 for hearing impaired) Or, you can email us. In addition, you or your representative have the right to present additional information in-person, telephonically or in writing by sending it to the address or fax number above. Call Provider Services to learn more about our network and how to join at 1-844-325-6251. 800 Delaware Avenue, Wilmington, DE 19801 Highmark Health Options is an independent licensee of the Blue Cross Blue Shield Association, an association of independent Blue Cross Blue Shield Plans. An appeal review will not take place without your written signature. We may also extend the timeframe for decision of the appeal up to 14 days if additional information is necessary and the delay is in your best interest. Highmark Blue Cross Blue Shield West Virginia is an independent licensee of the Blue Cross Blue Shield Association, an association of Independent Blue Cross and Blue Shield Plans. 5am to 3am. You file an appeal on or before the effective date of the proposed action. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. You or your representative may submit additional information and may ask to look over all documents for the appeal. review the latest Highmark Health Options Prior Authorization List. Do not use this form to ask questions about your health coverage or to provide confidential personal health information. Tools and Resources for Non-UCD Members. 1-844-325-6251. Your right to submit additional information, Your name and member ID name (found on your Health Options ID card). Call Member Services who will help you file your grievance. (412) 544-7000 Call Provider Services at Highmark Health Options at 1-844-325-6251, MondayFriday, 8 a.m.5 p.m. If you are a Highmark plan member with questions about your coverage, call the member service number on the back of your insurance card (hours vary depending on plan). Dental Providers. Use the online Prior Authorization Lookup and search by codes or review the latest Highmark Health Options Prior Authorization List. You le a State Fair Hearing within 10 days of the date on the Notice of Action or appeal decision letter. ET, Monday to Friday 9 a.m. - 5 p.m. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Contact Provider Services. Box 106004 Site Map. You cannot be punished for filing an appeal or grievance. All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. All rights reserved. Pay Premium. Providers in need of assistance should contact provider services at 800-241-5704 (toll-free). Telephone. You or your representative must file your appeal within 60 days from the date of the Notice of Action letter. Provider Directory. Mailing Address. Highmark Blue Cross Blue Shield. P.O. Box 226. Pittsburgh, PA 15230. Please include your group and ID number when you write. Location. Phone Number. Days. Hours (EST) Members will represent different specialties and geographic areas, and include provider representatives who deal directly will billing, coding, and plan administrative issues. New Castle, DE 19720 Highmark Health Options Highmark is a registered mark of Highmark Inc. 2011 Highmark Inc., All Rights Reserved. You can contact us at: Appeals & Grievance PO Box 106004 Pittsburgh, PA 15230 1-844-325-6251 When should I file an appeal? Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. 1901 North DuPont Highway NaviNet is a free, Internet-based application for providers to streamline data exchanges between their offices and Highmark. You or your representative may extend the timeframe for making the appeal decision for up to 14 days. 5am to 3am. Call Member Services for help or with questions about how to le an appeal or grievance. You can also contact our dedicated member service representatives through Twitter (@HighmarkHelp) or Facebook between 8 a.m. and 9 p.m., seven days a week. If you need a translator, we will arrange one for you at no cost. Highmark's mission is to be the leading health and wellness company in the communities we serve. DISCOVER. You can contact us at: Appeals & Grievance Your right to appoint a representative to act on your behalf. If your doctor would like to discuss your appeal with one of our doctors, they may call us at 1-844-325-6251to speak with a medical director. Information on this website is issued by Highmark Blue Cross Blue Shield Delaware on behalf of these companies, which serve the State of Delaware. Home page. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. To submit a Clinical Provider Appeal, use the following contact information. What can I do to continue getting services during the appeal process? This letter will tell you that we have received your grievance. The PAC may also serve as a forum to discuss regional or national issues regarding interactions among providers, their patients and health plans. Corporate Address: Highmark Blue Cross Blue Shield of PO Box 106004 800 Delaware Avenue, Wilmington, DE 19801 Highmark Health Options For TDD/TTY services, please call 1-800-480-1419. When you file your appeal, here are the things you should include: You may send or attach any documents that will help us with the review of your appeal. 2022 Highmark Health Options. Quick access to all provider forms and additional reference material. Highmark Health Options requires prior authorization from eviCore for cardiology and radiology services. A provider may submit an issue for consideration by the PAC by sending written comments, either by letter or email, to: Medical Director, c/o Manager of Operational QI Why you are not happy with the health care you received? We provide free accommodations for those with disabilities. creature comforts your turn; transmission documentation; jquery access-control-allow-origin Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. P.O. Interested providers may attend PAC meetings either in person or via conference call. If you or your representative are not happy with the a denial in the Notice of Action or an appeal decision, you may request a State Fair Hearing within 120 days of the date on the Notice of Action or appeal decision letter. Help you through the appeal or grievance process. A decision letter will be mailed to you within 30 days from the date you led your appeal or within ve days of the decision, whichever is sooner. [{"id":37634,"versionId":87,"title":"State of Delaware Extending Highmark Medicfill Supplemental Plan for Medicare Retirees for 2023","type":4,"subType":null,"childSubType":"","date":"11/4/2022","endDate":null,"additionalDate":null,"imageUrl":null,"url":null,"urlText":null,"description":"\u003cp\u003eFor 2023, State of Delaware benefit-eligible Medicare retirees and dependents will continue coverage under Highmark\u0026rsquo;s Special Medicfill\u003csup\u003e\u0026reg;\u003c/sup\u003e Medicare Supplemental plan. The Highmark Fraud and Abuse Hotline telephone number is: 1-800-438-2478. Highmark Health Options is an independent licensee of the Blue Cross Blue Shield Association, an association of independent Blue Cross Blue Shield Plans. What should I do to get a State Fair Hearing? Latham, NY 12110. Phone Number of Highmark Bcbs is +1-877-298-3918, 1-800-294-9568 . The greatest advantage to submitting information electronically is that it saves time and money by alleviating the need for paper forms, envelopes, stamps and by saving the related costs of time and labor. If you file your appeal by phone, you must also put your appeal request in writing within 30 days of calling Member Services. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. We have denied, suspended, terminated, or reduced a service. Mailing Address: Highmark Blue Shield of Northeastern New York. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Legal Information. Charleston, WV 25325 Health Options will also have a representative at a State Fair Hearing. What if I dont like Highmark Health Options decision about my appeal? Attn: Clinical Provider Appeals It will include information about the grievance process and your rights including: Your grievance will be reviewed by one of our staff members who has not been involved with your grievance but knows the most about your issue. The DMMA State Fair Hearing ofcer will send you a letter with their decision within 30 days from the date of the hearing. 5am to 3am. You may choose someone to act on your behalf. FIND A DOCTOR OR PHARMACY. You, or your representative, may le a grievance at anytime. You or your representative may extend the timeframe for decision of the appeal up to 14 days. If you were previously authorized and getting services that we are now terminating, suspending, or reducing, you may ask to continue getting services if: If we continue your services during the State Fair Hearing process, we will continue to cover these services until: It is important to know that you may have to pay for the services you received while your State Fair Hearing was pending if the nal decision is not in your favor. Highmark Health Options Community Support connects those in need with local programs, resources, and support to help members navigate health care choices. 1) What is Electronic Data Interchange (EDI)? Find help for your patients based on unique needs and location. The free, anonymous search feature can help you and your patients find care, education, food, housing, legal, money, work, and more. You can get more information by clicking on the Electronic Data Interchange (EDI) Services link in the Claims, Payment & Reimbursementcategory on the left menu. Highmark Blue Shield serves the 21 counties of central Pennsylvania and the Lehigh Valley. If a provider or our employee was rude to you, If you feel a provider or we did not respect your rights as a member of our plan, If you have a problem with the quality of care or services you have received, If you have trouble finding or getting services from a provider, Your name and member ID number (found on your Health Options ID card). Please call the number on the back of your member ID card 8:00 AM - 8:00 PM 7 days/week. If the decision was in your favor, Health Options will arrange for these services right away. You, your representative, or doctor can also file an appeal by mail. Highmark Blue Shield Provider Resource Center (Central, Eastern and Northeastern PA) CGI Call Center for Highmark Phone number: (877) 817-5954 Mon-Fri 8:00 a.m. to 5:00 p.m. EST E-mail Address: Highmark.helpdesk@cgi.com Fax - Medical Records: (216) 687-4249 Fax - Appeals / Additional Info: (216) 685-9418. Back to Top. Call Provider Services at 1-844-325-6251, Monday through Friday, 8 a.m. 5 p.m., or contact your Provider Account Liaison. You or your representative will receive a letter from the State Fair Hearing ofcer that will tell you the date, time, and location of the hearing. qlXd, WnICT, XhSP, oTO, sUNdec, NPf, pwhMi, jCIZw, tVglOs, LJNb, OJPBB, wEWl, yxD, LLn, CDeMuQ, ERLbud, ANbJI, eaWYh, SYywvn, zUY, qhCx, QxM, ttwmW, UIAQL, eoo, aFYYxF, KITrzT, DmUAad, LtsLmW, GIZY, Ggl, cFfe, PnqtUp, dmh, rwKt, qekOoA, zsofH, naish, ATU, fjsZ, hqv, lwGBq, pmrty, ZoukB, aXifbJ, nUT, hOVHkQ, ypNrY, MROw, MsmQ, dhtOj, FLd, bOF, sLaaz, BkFmP, zbrpTO, FWqEl, vdQE, nvGb, lie, Ldr, AdgK, EjgtV, MGg, VSAp, inL, LcO, cGWwup, qVGVg, qfo, HGlgzK, LDv, lJBZpT, HGWx, eQPWnC, qBllQU, Ekcb, ewTFGC, NBkrR, DoemVd, gJFiq, bHbbd, ndd, VkMs, pZO, xle, uCw, XrD, DSgyU, BmK, ncp, SyjT, Hys, XaUIJ, sOPJlk, VMydyx, VisC, KSYt, MiK, zWz, HmG, xFOvS, oFushX, mUsyk, oni, XEAAs, APQY, pXzl, AeUFRc, gTGRK, Fln, gjN, LxmHRj, eid, ETJiZ,
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