June 21, 2012, reposted February 24, 2016

Attention New York Customers: Important information regarding expanded editing

Highmark Western and Northeastern New York is only responsible for processing FEP (Federal Employee Program) claims for part of New York State, and Highmark Western and Northeastern New York is only responsible for handling Blue Card Host claims from providers that are in our BlueCross servicing area.  

Effective 6/24/12, a new set of edits have been put into place to reject these claims up front at ASK which will eliminate Highmark Western and Northeastern New York from handling the claim, as well as reject the claim back to the provider faster and more efficiently.  This will allow the provider to submit to the correct plan in a timely manner.

ITS Host edits:

• Professional
  A7:116 / A7:126:85 (Bill local plan - location checked at the billing provider zip code)
  A7:116 / A7:126:77 (Bill local plan – location checked at service location zip code) 
   
• Institutional 
  A7:116 / A7:126:85 (Bill local plan – location checked at service location zip code)

FEP edits:

• Professional
  A7:116 / A7:126:85 (Bill local plan – location checked at the billing provider zip code)
  A7:116 / A7:126:77 (Bill local plan – location checked at the service location zip code) 
   
• Institutional 
  A7:116 / A7:126:85 (Bill local plan – location checked at the billing provider zip code) 
   
• Dental
  A7:116 / A7:126:85 (Bill local plan – location checked at the billing provider zip code)
  A7:116 / A7:126:77 (Bill local plan – location checked at service location zip code)

Highmark Western and Northeastern New York FEP Institutional Zip Code List

Highmark Western and Northeastern New York FEP Professional and Dental Zip Code List