A newsletter for the Highmark Blue Cross Blue Shield providers in western Pennsylvania
Issue 11, November 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-064 Government Supplied Vaccinations and Antibody Treatments
Policy will be updated to delete vaccine codes.
RP-070 Continuous Rental of Life Sustaining DME
This policy was reviewed as part of our standard review process. No changes in direction were made
RP-072 Injection and Infusion Services
Effective January 1, 2024, Highmark will be applying a system enhancement to identify when chemotherapy administration codes are billed and enforce the direction currently defined on Reimbursement Policy (RP)-072. For providers, this enhancement will reduce administrative costs associated with claim audits and adjustments by supporting the correct adjudication of claims before the finalization of initial claim processing.
RP-037 Emergency Evaluation and Management Coding Guidelines
Outpatient surgery will be removed from the exclusion criteria.
