Highmark Blueshield Neny Prior Authorization Lookup
Latest Highmark Blueshield Neny prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Prior authorization and utilization management for specialty and injectable drugs and selected servicesDefines authorization pathways and UM program assignments for specialty/injectable drugs and selected services for Highmark BlueShield members in specified states; informs providers how to determine plan-specific authorization requirements.All Highmark Blueshield Neny updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-04-01List of procedures/DME requiring prior authorizationThis document lists procedures, drugs, and DME that require prior authorization for Highmark BlueShield members in Pennsylvania, West Virginia, and Delaware; it informs providers which codes/modalities may need authorization and plan-specific verification.All Highmark Blueshield Neny updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-02-20List of procedures/DME requiring prior authorization (PA/WV/DE)This document lists procedures, modalities, and HCPCS/CPT codes that require prior authorization for Highmark BlueShield NENY members in PA, WV, and DE and explains plan-specific verification methods for providers.All Highmark Blueshield Neny updates
- Prior AuthAdministrative/Operational PolicyEff. 2019-01-01Codes Requiring Prior Authorization for the Advanced Imaging and Cardiology Services ProgramLists CPT/HCPCS procedure codes that require prior authorization under Highmark BlueShield's Advanced Imaging and Cardiology Services Program; applies to providers submitting imaging and cardiology service claims.All Highmark Blueshield Neny updates
- Prior AuthAdministrative/Operational PolicyEff. 2019-01-01Codes Requiring Prior Authorization for the Advanced Imaging and Cardiology Services ProgramAll Highmark Blueshield Neny updates
- Prior AuthClinical/Medical PolicyEff. 2018-01-01Preferred Products for Medicare Advantage — Preferred drug products and biosimilarsLists preferred and non-preferred pharmaceutical products and biosimilars for Highmark Medicare Advantage plans and describes that preferred-product utilization management (including prior authorization) applies to FDA-labeled indications consistent with CMS guidance.All Highmark Blueshield Neny updates
- Prior AuthClinical/Medical PolicyAddyi (flibanserin) prior authorization and reauthorization formThis document is a prior authorization and reauthorization request form for Addyi (flibanserin) used to treat hypoactive sexual desire disorder (HSDD) in premenopausal females. It governs requirements providers must submit to Highmark BlueShield for coverage consideration.All Highmark Blueshield Neny updates
- Prior AuthClinical/Medical PolicyArmodafinil (Nuvigil) — Prior Authorization Coverage Criteria for Sleep DisordersForm and criteria governing prior authorization requests for armodafinil (Nuvigil) for sleep disorders (narcolepsy, obstructive sleep apnea, shift-work sleep disorder) submitted to Highmark BlueShield (Northeastern NY payer network). Affects prescribing providers requesting coverage for these medications.All Highmark Blueshield Neny updates
- Prior AuthClinical/Medical PolicyBotulinum toxin prior authorization — chronic migraine, hyperhidrosis, and other usesGoverns prior authorization information and clinical questions required for medical benefit administration of botulinum toxin for chronic migraine, hyperhidrosis, and other uses for Highmark BlueShield regions. Affects ordering providers, administering facilities, and specialty pharmacies submitting requests.All Highmark Blueshield Neny updates
- Prior AuthClinical/Medical PolicyDiabetic Blood Glucose Monitoring Supplies Prior AuthorizationThis document governs prior authorization and clinical information collection for diabetic blood glucose monitoring products and supplies requested for Highmark Blue Shield members; it affects prescribing providers requesting coverage for these products.All Highmark Blueshield Neny updates
- Prior AuthClinical/Medical PolicyDupixent (dupilumab) prior authorization request form coverage criteriaForm and clinical intake questions used to request prior authorization for Dupixent (dupilumab) for multiple indications (atopic dermatitis, asthma, eosinophilic esophagitis, chronic rhinosinusitis with nasal polyposis, prurigo nodularis, COPD, chronic spontaneous urticaria). Affects prescribing providers and prior authorization reviewers for Highmark BlueShield NE/NY membership.All Highmark Blueshield Neny updates
- Prior AuthClinical/Medical PolicyEmgality (galcanezumab) prior authorization form for migraine/cluster headache prophylaxisA medication prior authorization form used by Highmark BlueShield for Emgality (galcanezumab) to document clinical indications, prior therapeutic failures/intolerance, dosing (including loading dose), concurrent CGRP use, and reauthorization effectiveness criteria for episodic migraine, chronic migraine, and episodic cluster headache.All Highmark Blueshield Neny updates
- Prior AuthClinical/Medical PolicyEvenity (romosozumab) — Outpatient Injectable Authorization CriteriaAuthorization form and clinical questionnaire for outpatient administration of Evenity (romosozumab) under the medical benefit; intended for providers requesting prior authorization for Highmark BlueShield members in the applicable service region.All Highmark Blueshield Neny updates
- Prior AuthClinical/Medical PolicyEvolocumab (Repatha) prior authorization coverage criteriaDefines the information and clinical criteria required for prior authorization of Evolocumab (Repatha) injections for members of Highmark BlueShield regions. Affects prescribing providers (cardiologists, lipid specialists, endocrinologists, PCPs) and pharmacy/benefit reviewers processing Repatha requests.All Highmark Blueshield Neny updates
- Prior AuthAdministrative/Operational PolicyFederal Employee Program (FEP) services requiring prior authorization or notificationLists Federal Employee Program (FEP) services that require prior authorization or prior notification across plan types (Standard & Basic and FEP Blue Focus); affects providers and facilities submitting authorization/notification for covered services.All Highmark Blueshield Neny updates
- Prior AuthClinical/Medical PolicyHemophilia / Bleeding Disorder Medication Prior Authorization Form Coverage CriteriaCovers prior authorization documentation and clinical criteria required for authorization of hemophilia and bleeding-disorder therapies for Highmark Blue Shield members; affects prescribing providers requesting coverage for factor products and related medications.All Highmark Blueshield Neny updates
- Prior AuthClinical/Medical PolicyIn Vitro Fertilization (IVF) Coverage CriteriaDefines medical indications and prior authorization information for IVF coverage for Highmark BlueCross BlueShield Delaware members; intended for providers requesting authorization and documenting infertility diagnoses and prior treatments.All Highmark Blueshield Neny updates
- Prior AuthClinical/Medical PolicyIn Vitro Fertilization (IVF) coverage request — Provider questionnaire for prior authorizationThis document is a provider-facing IVF coverage determination questionnaire used by Highmark BlueShield to collect patient history, infertility work-up, and proposed treatment for prior authorization decisions. It affects providers seeking coverage approval for IVF for Highmark BCBS members in the governed state(s).All Highmark Blueshield Neny updates
- Prior AuthAdministrative/Operational PolicyMedicare Part D Hospice Prior Authorization for Non‑Hospice MedicationsForms and instructions for hospice providers to request Medicare Part D coverage of prescription drugs believed not to be covered under the Part A hospice benefit; affects hospice providers, prescribers, and PBMs managing Medicare Part D for Highmark members.All Highmark Blueshield Neny updates
- Prior AuthClinical/Medical PolicyMedication Prior Authorization Form - Coverage CriteriaForm and instructions to request prior authorization for prescription medications for Highmark members; used by prescribing providers to submit clinical and administrative information required for authorization decisions.All Highmark Blueshield Neny updates
- Prior AuthClinical/Medical PolicyMedication Prior Authorization Form for weight-loss medicationsA fillable prior authorization (PA) request form used by Highmark BlueShield entities for requesting coverage of a single medication (primarily weight-loss agents/GLP-1 receptor agonists). It collects member, provider, medication, clinical history, documentation attachments, and signature to support PA determination.All Highmark Blueshield Neny updates
- Prior AuthClinical/Medical PolicyMedication Prior Authorization Form — Ajovy (fremanezumab) for Migraine PreventionForm and requirements for prior authorization of Ajovy (fremanezumab) for migraine prophylaxis, used by providers submitting requests for Highmark BlueShield members in North Carolina.All Highmark Blueshield Neny updates
- Prior AuthClinical/Medical PolicyMedication Prior Authorization Form — ContraveForm and requirements for prior authorization requests for the weight-loss medication Contrave submitted to Highmark BlueShield NE/NY; governs providers requesting PA for members in the payer's service area.All Highmark Blueshield Neny updates
- Prior AuthClinical/Medical PolicyMedication Prior Authorization Form — Migraine Prophylaxis (Aimovig)This form governs prior authorization requests for migraine prevention medications (specifically Aimovig is referenced) for Highmark Blue Shield members in North Carolina and collects member, provider, medication, and clinical information to determine coverage.All Highmark Blueshield Neny updates
- Prior AuthClinical/Medical PolicyMedication Prior Authorization for OpioidsForm and requirements for prior authorization of opioid medications for Highmark BlueShield members in North Carolina; governs what provider-completed documentation and clinical information are required to request authorization.All Highmark Blueshield Neny updates
1–25 of 78
1 / 4
Tool Description
Search Highmark Blueshield Nenyprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Prior Authorization by Payer
Go deeper
Explore OpenPayer Data
Prior auth requirements change all the time. Keep up with every payer policy update in the live policy feed, or browse payers with prior authorization policies.
Toolbox
More OpenPayer Tools
- Billing Code LookupSearch CPT, HCPCS, J-codes, DRG, and dental codes by number or procedure name.
- Healthcare Provider & Facility LookupFind hospitals and healthcare facilities by name, taxonomy, facility type, ownership, or state.
- Health Insurance Payer LookupSearch national health insurance payers and health plans by name and state presence.
- Provider Taxonomy Code LookupSearch NUCC taxonomy codes by code, specialty, grouping, or classification.
- CPT Modifier LookupSearch CPT modifiers by code or name — descriptions, when to use them, and payer policy context.
- Timely Filing LookupFind payer timely filing policies: claim deadlines, corrected claim windows, and appeal timeframes.
- Coverage Criteria LookupSearch payer coverage criteria and medical necessity requirements by drug, procedure, or payer.
- Payer Contact DirectoryClaims, prior authorization, provider services, and appeals contacts for health insurance payers.
Published by
Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.