Category: BCBS Empire NY

Find medical coding and medical billing guidance for BCBS Empire NY Plans

Posted in BCBS Empire NY, NY Providers, Payer Updates, Training

Anthem BCBS: 32BJ fund new TPA and cards

Posted on by KR2Medical Billing

As the new year starts so do the change of theember ID changes and or group numbers.

Is your provider office aware of these changes?

Please note that for any 32BJ members there is a new TPA, group#, member ID, and cards.

Please note the new ID:

Effective Jan 1,2026- new members ID prefix BJVBJ.

Image via Anthem BCBS

For OON probiders- please make sure to submit your claims directly to the TPA- WebTPA.

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Posted in #reimbursement, BCBS Empire NY, NY Providers, Payer Updates, Prior Authorization Insurance Carrier Updates

Anthem BCBS NY: New PET tracer UM policy

Posted on by KR2Medical Billing

The following information will apply to any DOS on 12/1/25 and thereafter.

Starting 12/1/25 the PET tracer will require an auth in addition to PET services.

Please submit both PET and radiotracer codes- for prior authorization. The UM criteria for PET will not be affected. However both codes will be either approved or denied. Please note that the radiotracer must coorespond to the requested PET code.

The following codes will be affected:

Image via Anthem BCBS
Image via Anthem BCBS
Image via Anthem BCBS

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Posted in #reimbursement, BCBS (Various States), BCBS Empire NY, NY Providers, Pharmacy (Various Insurance Payers)

BcBS HighMark NY: coverage for COVID-19 vaccine

Posted on by KR2Medical Billing

According to Highmark BCBS- the COVID-19 vaccine will be covered with out any pocket costs through 2025-2026.

This currently only applies to Managed Medicaid, Child Health Plus, Essential and HARP plan types.

The vaccine will still be part of standard preventive care benefits, COVID‑19 vaccines are covered for all members older than 6 months of age.

Members are encouraged to contact their primary care or pharmacy for vaccine availability.

Highmark will partner with Wellpoint companies to administer this benefit.

As per Highmark-Wellpoint Insurance Services, an independent company, administers utilization management services for Highmark Blue Cross Blue Shield’s managed Medicaid.
Wellpoint Partnership Plan, LLC provides management services for Highmark Blue Cross Blue Shield’s managed Medicaid.

Certain sef-insured plans have special vaccine coverage and should check their benefits coverage for more info.

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