If you are a laboratory provider that accepts Highmark BCBS insurance in your office/facility, then this blog post is for you!

A new vendor to offer prior authorization review: HealthHelp.

What is changing for NYS providers?

NYS – most of the molecular/genetic laboratory procedures do not require an authorization. Starting for any DOS 10/1/26 and thereafter, more molecular/genetic procedure codes will be included in the prior authorization list.

What is changing for PA, DE, WV providers?

EviCore will stop performing prior authorization services. Instead, the new vendor HealthHelp will replace EviCore. As a result of this change there will be additional molecular/genetic testing lab tests will be added to the prior authorization list.

Plan types that will be affected by this change:

• Commercial fully insured; Affordable Care Act (ACA); Medicare Advantage
• Self-funded Administrative Services Only (ASO) members in Delaware, Pennsylvania, and West Virginia
• Child Health Insurance Program (CHIP) members in Pennsylvania

Some of the types of tests that will be handled by the HealthHelp are:

• Hereditary cancer screening
• Carrier screening tests
• Tumor marker/molecular profiling
• Hereditary cardiac disorders
• Cardiovascular disease and thrombosis risk variant testing
• Pharmacogenomic testing
• Neurologic disorders
• Mitochondrial disease testing
• Intellectual disability/developmental disorders

To submit an auth:

• Initial request – please go through Availity Essentials portal.
• Once the initial request is submitted the providers will be re-routed to HealthHelp portal via Predictal

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Downloadable Reference Guide, click here.