We’re delighted to learn that you’d like to join the Highmark Blue Cross Blue Shield of Western New York Medicaid network (Highmark BCBSWNY). We have a large network of outstanding health care professionals who ensure that our members have continuous access to the care they require. You improve the lives of your patients. We will extend the same courtesy to you.
Precertification, referrals, claims, and payment processes have all been simplified to allow you to focus on what you do best: caring for your patients.
Obtaining a Highmark Credential
The process by which Highmark Blue Cross Blue Shield of Western New York evaluates and selects licensed independent practitioners to provide care to our members is known as credentialing.
The Council for Affordable Quality Healthcare (CAQH) ProView application is used by Highmark BCBSWNY for credentialing. The amount of paperwork you have to fill out to complete the credentialing process is reduced thanks to this secure and private website.
Overview of Credentialing
To ensure the competency and conduct of the health care professionals serving members in our network, credentials are evaluated according to criteria set forth in our policy.
The process of obtaining credentials
- CAQH ProView is required for all providers applying for initial or continuing participation to complete and submit their credentialing and credentialing applications. When using ProView, keep the following tips and reminders in mind.
- Make an account with CAQH (if you are not already registered). Self-registration is also possible through a secure and private website.
- Allow Highmark BCBSWNY to access your credentialing information by giving us permission. You must give us permission to review your information if you have already registered with CAQH. (Highmark BCBSWNY already has access to your data if you chose Global Authorization.)
To authorize Highmark BCBSWNY, follow these steps:
- Enter your username and password at https://proview.caqh.org/pr.
- Select Authorize from the cogwheel in the upper right corner.
- Scroll down until you find Highmark BCBSWNY and check the box next to it.
- To submit your changes, select Save.
There are five Fantastic advantages to credentialing with Stars Pro
Mindfulness
The records and work history are double-checked. We are aware of CAQH requirements as well as Medicare requirements. We collect and verify copies of providers’ licenses, degrees, and peer-reviewed articles. We take care of it so you don’t have to.
Efficiency of Time
You are the foremost authority in your field. You spent years learning how to care for patients in medical school. However, the more time you spend on tasks unrelated to your training, the less time you have to use your skills. Allow us to take care of the paperwork.
Expansion
One of the most effective ways to expand your patient base is to acquire more approved providers and payers. Keeping track of payers, however, is critical because credentialing can take 90 to 150 days once the payer receives documentation. We’ll quickly and efficiently add insurers to your network.
Consolidation
There are a variety of credentialing requirements and application processes for different practices. We’ll check the requirements if you acquire new providers or if you complete a merger and need to incorporate providers all at once.
Maintenance
To keep a practice current, providers must be re-credentialed every few years. We will keep track of re-credentialing timelines to avoid any service interruptions.