Highmark Blue Shield of Northeastern New York
Welcome to the Highmark Blue Shield of Northeastern New York page. Here you can download clinical guidelines, policies and procedures specific to both ordering providers and radiation oncology facilities. These include quick reference guides and FAQs. You can also view information designed to assist you in using the RadMD Website to obtain and check authorizations.
If you have any questions about the NIA Program, please contact your dedicated NIA Provider Relations Manager, Charmaine Everett.
Update on COVID-19
Radiation Oncology Benefits Management
Effective November 1, 2019, Radiation Treatment preauthorization requests for all types of cancer and conditions should be submitted through Magellan Healthcare for Highmark Blue Shield of Northeastern New York Commercial and Medicare Advantage membership.
Treatment Plan Checklists
- Anal Cancer
- Bone Metastatic Cancer
- Bone Primary Cancer
- Breast Cancer
- Central Nervous System (CNS) Metastatic Cancer
- Central Nervous System (CNS) Primary Cancer
- Cervical Cancer
- Colon Cancer
- Endometrial Cancer
- Gastric Cancer
- Head and Neck Cancer
- Hodgkins Lymphoma
- Non-Hodgkins Lymphoma
- Lung Cancer (Non-Small Cell)
- Lung Cancer (Small Cell)
- Other Condition
- Other Metastatic Cancer
- Pancreas Cancer
- Prophylactic Cranial Irradiation
- Prostate Cancer
- Rectal Cancer
- Skin Cancer
CPT4 Codes and Covered Procedures
- Highmark Blue Shield of Northeastern New York Radiation Oncology Utilization Review Matrix 2021
- Highmark Blue Shield of Northeastern New York Utilization Review Matrix 2021
- Highmark Blue Shield of Northeastern New York Utilization Review Matrix PEF Only 2021
Program and Provider Education
- Highmark Blue Shield of Northeastern New York Quick Reference Guide
- Highmark Blue Shield of Northeastern New York Frequently Asked Questions
- Highmark Blue Shield of Northeastern New York Provider Education Presentation
- Highmark Blue Shield of Northeastern New York Radiation Therapy Treatment Notification Form
RadMD Documents
RadMD is our user-friendly, real-time tool that provides you with instant access to the high-tech imaging authorization and supporting information you need. Whether submitting imaging exam requests or checking the status of a prior authorization request, you will find RadMD to be an efficient, easy-to-navigate resource.
Search for resources by solution below:
Radiology Benefits Management Program
Recorded General Trainings
We have a series of training videos that discuss the components of requesting a prior authorization request. Click here to access these videos.
Recorded RadMD Demos
Need additional help using RadMD? Click here to access a series of RadMD demos that demonstrate how to properly submit a prior authorization request.
Clinical Guidelines
- Clinical Guidelines
- Refer to the Utilization Review Matrix document to view specific codes managed by NIA
Clinical Training Modules
We have a series of clinical training modules that will help you avoid delays and ensure that you have the right information before submitting your prior authorization request. Click here to access them.