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Governing Policy and Procedures

Beginning Jan. 1, 2016, providers will be governed by two sets of Policies and Procedures as they relate to treating patients:

  • Patients who are still covered by First Priority Health (FPH) and First Priority Life Insurance Company (FPLIC) health plans because their coverage has not yet renewed for 2016
  • Patients who are now covered by Highmark Blue Cross Blue Shield health plans because their coverage has renewed for 2016 and they have transitioned to a Highmark plan

Please Note: Effective Jan. 1, 2016:

  • Patients that present a BCNEPA-branded ID card with a FPH/FPLIC alpha prefix are bound by the Policies and Procedures outlined in the BCNEPA Professional and Facility Policy and Procedure manuals.
  • Patients that present a Highmark Blue Cross Blue Shield-branded ID card are governed by the Policies and Procedures outlined in the Highmark Blue Shield Office Manual and Highmark Facility Manual.

As always, it is essential that you review each patient’s member ID card and compare it to that member’s current Eligibility and Benefits (E&B) information on NaviNet to ensure the correct insurer’s policies/procedures apply.

To check E&B information for patients with a FPH/FPLIC alpha prefix, please utilize NEPA/FPH NaviNet, and for checking E&B information on patients with a Highmark BCBS alpha prefix, please utilize Highmark NaviNet.

Providers need to continue to check all future issues of the Provider Bulletin for updated alpha prefix information, including the complete alpha prefix chart once it is available

Select the provider form you wish to complete from the menu. These forms are to be used ONLY by physicians and/or facilities when requesting authorization for services.