Highmark Blue Shield of Northeastern New York
Welcome to the Highmark Blue Shield of Northeastern New York Health Plan page. Here you can download policies and procedures specific to both ordering and rendering providers. These include quick reference guides and information designed to assist you in using RadMD to request and check the status of prior authorizations.
If you have any questions about our programs, please contact your dedicated NIA Provider Relations Manager, Lori Fink.
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 2022
- Highmark Blue Shield of Northeastern New York Utilization Review Matrix 2022
- Highmark Blue Shield of Northeastern New York Utilization Review Matrix PEF Only 2022
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
- Highmark Blue Shield of Northeastern New York Peer-to-Peer Process
Conservative Treatment Forms
For access to our conservative treatment forms, click here.
RadMD Documents
RadMD is a user-friendly, real-time tool offered by Magellan Healthcare that provides ordering and rendering providers with instant access to prior authorization requests for specialty procedures. Whether submitting exam requests or checking the status of prior authorization requests, providers will find RadMD to be an efficient, easy-to-navigate resource.
Search for resources by program:
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.
Update on COVID-19
Click here to view our recommendations on the use of CT to detect Coronavirus (COVID-19).