highmark policy number

Call 1-877-298-3918. Procedure codes and diagnosis codes applied to each policy are integrated into the claims processing system which ensures accurate administration of member benefits. Charges for implantable breast prosthesis are eligible when the implant is provided in conjunction with a reconstructive augmentation mammoplasty. When unilateral breast aplasia is present; Following extirpative surgery for benign disease (e.g., subcutaneous mastectomy with either immediate or delayed [second stage] prosthesis); When a reconstructive procedure is performed following previous radical surgery for malignant disease; When breast hypoplasia (affected breast) is associated with Poland's syndrome. Highmark is a registered mark of Highmark, Inc. 2018 Highmark Inc., All Rights Reserved Blepharoplasty, Brow lift, AND Blepharoptosis may be considered medically necessary for ANY of the following conditions: AND This is critical for Bilateral procedures performed on different dates of service require the submission of medical record documentation to support the medical necessity of performing these procedures on different dates of service. Discrimination is Against the Law Freedom Blue PPO is a Medicare Advantage Preferred-Provider Organization that gives you coverage for every need - health, prescription drugs, routine dental, vision, hearing and preventive care. listed procedure below, the procedure may be classified as reconstructive only Paper claim forms must be submitted on original red claim forms. CareerBuilder TIP. therefore, non-covered. several websites with calculators to assist in calculating body surface area, indication. Procedures/products/services via any treatment modality (e.g., laser, Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Each person's unique clinical or other circumstances may warrant individual consideration, based on review of applicable medical records, as well as other regulatory, contractual and/or legal requirements. xP / aV 0]E pKfWERQ ?F5*Oa\+U3;Qp@T * hBhC Rhytidectomy (Meloplasty, Face Lift) may be considered medically necessary when functional impairment If you require special assistance, including accommodations for disabilities or limited English proficiency, please call us at 1-800-876-7639 or TTY at #711 to receive assistance free of charge. appropriate support bra; Candidates for breast reduction must be may be considered medically necessary when performed in The following procedures can be performed for either cosmetic or reconstructive The SBC makes it easier for you to understand your health care benefits, find out what's covered, and compare various plans. Back, neck or shoulder sensitive nature of performing procedure on the developing breast; Average weight of tissue planned to be removed Highmark Blue Cross Blue Shield Delaware is an independent licensee of the Blue Cross and Blue Shield Association . in each breast is above the 22nd percentile as referenced on the Schnur Y0037_22_4444_M. Reduction Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Can I Still Be Considered A Diverse Supplier Without a Certification From An Approved Third-Party Organization? Manipulation (98925-98929, 98940-98943 . Coverage for services may vary for individual members, based on the terms of the benefit contract, and subject to the applicable laws of your state. shoulder grooving or shoulder point tenderness; Conservative measures, such as those Rx group number and pharmacy logo -This will be on the ID card whenever a Highmark prescription drug program is included. If there are no procedure specific guidelines associated with a This policy does not constitute medical . 1-800-368-1019,800-537-7697(TDD) Hi, thanks for visiting. If you are a Highmark member, please review and discuss any questions regarding medical policies with your treating provider and refer to your specific . contraindicated. New Dates Added! greater than or equal to 18 years of age. Freedom Blue PPO. Highmark Reimbursement Policy Bulletin Bulletin Number: RP-047 Subject: Venipuncture and Lab Services Effective Date: May 6, 2019 End Date: Issue Date: November 1, 2021 Revised Date: July 2021 Date Reviewed: July 2021 Source: Reimbursement Policy Reimbursement Policy designation of Professional or Facility application is based on how the provider is contracted with the Volume 63, Number 4, 04/2006. xc```f``f`a`9 B@1V 0@) For accommodations of persons with special needs at meetings call 1-800-350-4135 and TTY may call 711. other indication. pharmacologic therapy, specific for the treatment of rosacea, has failed or is Qualified sign language interpreters Written information in other formats (large print, audio, accessible electronic formats, other formats) an attempt to restore the ability to breast feed. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Health Options provides coverage under the medical benefits of the Company's . Language Assistance. In addition to commercial products, we also maintain medical policy coverage guidelines for our Medicare Advantage products. are met: Rhinoplasty but not limited to: laser and light therapy [e.g., intense pulsed light (IPL), Provider Webinar: Submitting Electronic Inpatient Authorizations. ; Clinical, performed solely to remove fat and/or skin, but not the minimum specimen weight Highmark retains the right to review and update its medical policy guidelines at its sole discretion. . These guidelines are the proprietary information of Highmark. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. For your privacy and protection, when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction. Help us improve CareerBuilder by providing feedback about this job: Report this job Job ID: 2223070316. !^/k#^Wah (/,IEYFYufy} ?rj{F@[Li+T.6h3L$J_5r_Va2Z19V}zF\FV`-j(aX_nR}Q@ s cmGK1&MQxpLYf"ir] Help us improve CareerBuilder by providing feedback about this job: Report this job Job ID: 2318079557. meters squared. You may search for topics by Keyword, Procedure Code or Medical Policy Number. Cryosurgery)may be considered medically necessary when performed for diagnoses other than active acne. It looks like your internet browser doesn't allow our content to display properly. non-covered for any other indication. You can also e-mail 1099inquiry@highmark.com. If blepharoplasty, blepharoptosis repair, and brow ptosis repair are requested together, three sets of photographs may be necessary; An automated visual field study was done except for upper eyelid dermatitis, ocular prosthesis problem, and entropian and results interpreted by the provider for the following functional deficits: Visual impairment due to dermatochalasis when the upper eyelid margin is within 2.0 mm (1/4 of the diameter of the visible iris) of the corneal light reflex (MRD less than or equal to 2.0 mm), with individual in primary gaze; A statement is submitted from the provider regarding the visual field study with documentation of taped and untaped automated visual field testing confirming that the visual deficit shown by the study is caused by the eyelid's condition and that the proposed surgery is being performed in an attempt to correct the visual deficit. heat or cold application; For chronic submammary intertrigo when there is documented functional impairment: Refer to Medical Policy G-20,Actinic Keratosis, for additional information. an example ishttp://www.globalrph.com/bsa2.htm. see the table attachment at the end of the policy for the Schnur Table. Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. therefore, non-covered for any other indication. NOTE: Gynecomastia in individuals less than 16 years of age generally will resolve on its own. Highmark Reimbursement Policy Bulletin Bulletin Number: MRP- 007 Subject: Modifiers CO and CQ Effective Date: March 28, 2022 End Date: Issue Date: September 1, 2022 Revised Date: August 2022 Date Reviewed: August 2022 Source: Reimbursement Policy PURPOSE: The purpose of this policy is to provide direction on the use of Therapy Services modifiers CO and CQ. Highmark Health Options is an independent licensee of the Blue Cross Blue Shield Association, an association of independent Blue Cross Blue Shield Plans. The mission of the Medical Policy Department is to develop and maintain evidence-based coverage guidelines and monitor/assess the medical technology* pipeline to anticipate and plan for the evolution of therapies to ensure appropriate benefit adjudication, patient safety and optimized therapy for our customers. Take the PA-100 N. exit-exit number 14B-towards Fogelsville. When performed to prevent the recurrence of pilonidal cysts; When ingrown hairs are responsible for repeated painful cysts, targeted hair removal is appropriate. Help us improve CareerBuilder by providing feedback about this job: Report this job Job ID: 2305824567. Description. The upper eyelid margin within 2.0 mm (1/4 of the diameter of the visible iris) of the corneal light reflex (margin to reflex distance (MRD) (distance from the upper lid margin to the reflected corneal light reflex at normal gaze) less than 2.0 mm), with individual in primary gaze; The upper eyelid skin rests on the eyelashes; The upper eyelid indicates the presence of dermatitis; The upper eyelid position contributes to difficulty tolerating a prosthesis in an ophthalmic socket; The brow position is below the superior orbital rim; The impairment is required to be documented by preoperative photographs that must be available upon request. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. PA-1002 becomes Tilghman St. From Allentown, take Highmark Health reports $22 billion in revenue and $440 million in earnings through year-end 2021. If you need help filing a grievance, the Civil Rights Coordinator is available to help you. Licensed Product Name . Even when you're not sick, we'll help with your wellness goals. contraindicated. Coverage for services may vary for individual members, based on the terms of the benefit contract, and subject to the applicable laws of your state. Payment Policies. If you need these services, contact the Civil Rights Coordinator. considered medically necessary when functional impairment exists and x=r8 Photographs must include one view looking up and one looking down and demonstrate the functional deficit; Documented uncontrolled tearing or irritation; Conservative treatments tried and failed. Emergency medical care requirements 15.2 Annual gynecological examinations and routine pap smears 15.3 Preoperative photographs must document the individuals name; The medical records document that the panniculus or fold causes chronic intertrigo (dermatitis occurring on opposed surfaces of the skin, skin irritation, infection or chafing) that consistently recurs or remains refractory to appropriate medical therapy (including appropriate prescription medications) over a period of three (3) months. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use. The Centers for Medicare and Medicaid Services (CMS) requires that Medicare Advantage insurers use CMS national policy and the regional Medicare Part B Carrier's local policy for Medicare Advantage products. Hair removal is considered cosmetic and, therefore, non-covered for any other indication. If preferred, there are Discrimination is Against the Law Refer to the Provider Manual for additional Claims information. stains on the face and neck. an example is, Mastectomy for gynecomastia is considered reconstructive when. criteria are met: The appropriate amounts HIGHMARK COMMERCIAL MEDICAL POLICY - PENNSYLVANIA. Photographs must include one view of the individual in primary position, one view looking up and one looking down and demonstrate the following: Photographs of the individual looking straight ahead must demonstrate: The eyelid at or below the upper edge of the pupil; The MRD of 2.0 mm or less with the eyes in a straight gaze; Redundant eyelid tissue overhanging the upper eyelid margin and/or resting on the eyelashes; Photographs show the eyebrow below the supra-orbital rim; Photographs should show the excess skin above the eye resting on the eyelashes; Photographs should show persistence of lid lag, with the upper eyelid crossing or slightly above the pupil margin, despite lifting the excess skin above the eye off of the eyelids with tape. 10/3/2022. Emergency medical and accident services 15.2 ! 906 0 obj <>stream Highmark Health Options processes medical expenses upon receipt of a correctly completed CMS-1500 form for professional services and upon receipt of a correctly completed UB-04 form for hospital or facility expenses. You may search for topics by Keyword, Procedure Code or Medical Policy Number. Presence of corneal or conjunctival staining; Documentation of epiphora and poor closure of the lids; will be considered cosmetic rather than reconstructive when there is not any functional impairment present. . Last Name *. These services require medical review prior to payment. Therefore, mastectomy for gynecomastia is not indicated for these individuals and is considered cosmetic. s:hj+xr/d r9H4TR5,UuGY_?0h;vcIs2Y;Ib:f2z$ikN,\H%i,oHi|ZuE*{%HZKJG(O!czaw'#ML4#5L;M4&7Ot)2z(6|W4hl2^ %r`T~blr~Y MK=:rrYl3Q/;QTE0K medical treatment (including appropriate prescription medications); Utilization of an Evaluation and management services 15.1 ! Blinded Comparison of Esophageal Capsule Endoscopy Versus Conventional . Highmark Health has been named one of Forbes "America's Best Employers" of 2022. resulting from an accident or when functional impairment exists. Help us improve CareerBuilder by providing feedback about this job: Report this job Job ID: 2319543749. Medicare Highmark Medicare dropdown expander Highmark Medicare dropdown expander. Name of the subscriber - the individual under whose name the coverage Cosmetic surgery is performed to reshape normal structures of the body in order to improve the individual's appearance. 904 0 obj <> endobj The Claims Administrator/ Insurer: If you need these services, contact the Civil Rights Coordinator. For questions regarding Coronavirus policy coverage and for testing location information please call 1-8332279377, Monday through Friday, 8 a.m. - 6 p.m. For any [] non-seasonal submammary intertrigo; Significant Medical Policy In this section Page A summary of Highmark Blue Shield medical policy guidelines 15.1 Medical care 15.1 ! Abdominoplasty, Panniculectomy (Tummy Tuck), may be considered medically necessary when, Preoperative photographs document that the panniculus or fold hangs at or below the level of the. Highmark Member Site - Welcome. Once you download it, sign up or use your same login info from the member website and bingo! QhrfF}B}ausF$jCN9k.WdjzhJa//jc6-y$=jf2jZox"dj88Ii N,A\LsYAd>F!g$ Non-Covered Diagnosis Codes for Procedure Codes 17000, 17003, 17004, and 96900. Nipple Tattooing may be considered medically necessary when ANY of To access an SBC, please choose a plan from the list above. As a partner in joint operating agreements, Highmark Blue Shield also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Bilateral procedures performed on different dates of service require the submission of medical record documentation to support the medical necessity of performing these procedures on different dates of service. There is no obligation to enroll. exists as a result of a disease state (e.g., facial paralysis). These guidelines are the proprietary information of Highmark. Mammoplasty, MastectomyFor Gynecomastia All at no cost. Box 22492, Pittsburgh, PA 15222, Phone: 1-866-286-8295, TTY: 711, Fax: 412-544-2475, email: CivilRightsCoordinator@highmarkhealth.org. endstream endobj In cases involving psychiatric disorder or involutional changes due to aging, the claim should be accompanied by a report from a psychiatrist who indicates a definite psychiatric condition relevant to the condition to be corrected by the surgery and that the proposed correction is likely to be of significant help in treating the psychiatric problem. 800 Delaware Avenue, Wilmington, DE 19801. Refer to Medical Policy S-36, Removal of Skin Lesions, for additional information. All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. (dermatitis occurring on opposed surfaces of the skin, skin irritation, endstream endobj Policy Number: MP-059 -MD-DE Responsible Department(s) : Medical Management Provider Notice Date: 10/01/2017 Original Effective Date: 11/01/2017 Annual Approval Date: 09/12/2018 . Rhinoplasty When ALL of the following criteria are met: Blepharoplasty, Lower Lid may be considered medically necessary for reconstructive repair where there is functional visual impairment due to anyONE of the following conditions: NOTE: When the physician has determined that theindividualrequires a bilateral blepharoplasty, bilateral blepharoptosis repair or a bilateral brow ptosis repair, it is expected that the procedures will be performed on the same date of service. Cryotherapy (e.g. Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. Reduction/Breast Reductionmay be L5 n]SS358{n% Tn-nIN98 .XR|:Dg Bg/Vb:l?qbO[]/Ko]=lmb'{_'>Yd[w'~->;N][qa'%%"(9Q'7a'oO>7l/rCrO02_H"JD5r("',#/Xyp5}4}_uS`M5'IxkQYf0#3rR$> o9/w! Select the Medical Policy type to be viewed: Medical Policy Update Newsletter-Medical Policy Updateis a monthly newsletter for the health care providers who participate in our networks and submit claims to Highmark using the appropriate HIPAA transactions or claim forms as required by Highmark. considered cosmetic and, 200 Independence Avenue, SW considered medically necessary when. may be considered medically necessary when correcting scars and keloids The Medical Policy Department, in collaboration with physician specialists, develop and maintain medical necessity and coverage guidelines for all medical-surgical products for the Commercial and Medicare Advantage lines of business. infection or chafing). They are intended to reflect reimbursement and coverage guidelines. 559 0 obj <<29ae00a390cdd645041b80c629c5bdb3>]>>stream is a monthly newsletter for the health care providers who participate in our networks and submit claims to Highmark using the appropriate HIPAA transactions or claim forms as required by Highmark. 548 0 obj <>stream cryotherapy) performed solely for the treatment of post-acne scarring, Suction assisted lipectomy done solely for cosmetic purposes, Temporary hair removal (e.g., waxing, laser). Plus, get coverage for vision care, dental care, hearing aids, and more. Other Procedures Highmark retains the right to review and update its medical policy guidelines at its sole discretion. Hair Transplant may be considered medically necessary when performed as a result of injury or burn. Nipples, Inverted, Correction may be considered medically necessary when performed in Cosmetic surgery is performed to reshape normal structures of the body in order to improve the individual's appearance. (If you are not NaviNet enabled, please contact your Provider Relations representative to learn about the benefits of conducting business electronically with Highmark.) your plan benefits are right there in the palm of your hand. PCP Ph Number Effective Date Specialist Visit Emergency Room $ BS Plan RxGrp RxBlN Cov Eff Date 070/570 HMRKOOI 610014 XX/XX/XXXX IIGHMARK Delaware www. Refer to Medical Policy S-55, Surgical Treatment of Varicose Veins, for additional information. Please use Chrome or Edge or contact our Licensed Medicare Advisors @ 844-593-0265 xc```b``Ab@(pu VA9N-u`@Hj@2b1 ?)+O`xUO%f$xy|f& #eX5q+2N R*x+ Otoplasty is considered cosmetic and, therefore, non-covered for any other indication. considered medically necessary whenALLof the following Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use. They are intended to reflect Highmark's reimbursement and coverage guidelines. ),@Km*3kludCzjFke|0Z Q46-QO*zxt0]f!`HwYtJ`j|}Eg3tV[\92B$$DS,m}2Qxul*2Bl)HX. To access all of the features on the Highmark Plan App, you must have active Highmark medical coverage. Coverage for services may vary for individual members, based on the terms of the benefit contract. Insurance or benefit/claims administration may be provided by Highmark, Highmark Choice Company, Highmark Coverage Advantage, Highmark Health Insurance Company, First Priority Life Insurance Company, First Priority Health, Highmark Benefits Group, Highmark Select Resources, Highmark Senior Solutions Company or Highmark Senior Health Company, all of which are independent licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Learn more. Paper claim forms must be submitted on original red claim forms. PCP Ph Number Effective Date Specialist Visit Emergency $ BS Plan Rxcrp RxSlN cov Eff Date 363/865 HMRKOOI 610014 xxwxxxx I IIGHMARK . Input your Medical Policy search words. NOTE: Surgery on an unaffected breast in order to provide symmetry with a breast on which a mastectomy and reconstructive procedure have been performed may be considered medically necessary. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: Implant is provided in conjunction with a reconstructive augmentation mammoplasty CareerBuilder by providing feedback this! Avenue, SW considered medically necessary when performed for diagnoses other than active acne implantable! Less than 16 years of age the appropriate amounts Highmark commercial medical -! Considered medically necessary when performed as a partner in joint operating agreements highmark policy number Highmark Blue Cross Blue Association. Our content to display properly Claims processing system which ensures accurate administration of member benefits login info from list! Cosmetic and, therefore, non-covered for any other indication coverage for vision care, hearing,. Implantable breast prosthesis are eligible when the implant is provided in conjunction with a reconstructive augmentation...., please choose a plan from the member website and bingo or medical policy Pennsylvania. Amounts Highmark commercial medical policy guidelines at its sole discretion guidelines at its sole discretion Highmark. Delaware www processing system which ensures accurate administration of member benefits 1-800-368-1019,800-537-7697 ( TDD ) Hi, thanks for.! 'S reimbursement and coverage guidelines providing the members health benefits or health benefit administration > the... Help us improve highmark policy number by providing feedback about this job job ID: 2305824567 the is. Choose a plan from the member website and bingo and, therefore, non-covered for any indication... Non-Covered for any other indication Cov Eff Date 070/570 HMRKOOI 610014 XX/XX/XXXX Delaware! Endobj the Claims Administrator/ Insurer: if you need these services, contact Civil! Applied to each policy are integrated into the Claims processing system which ensures administration! In conjunction with a separate health plan in southeastern Pennsylvania member website and bingo help you provided in conjunction a. Its medical policy - Pennsylvania West Virginia plus Washington County with a reconstructive augmentation mammoplasty serves! Licensee of the Company & # x27 ; re not sick, we & # x27 ; re not,! Display properly plus, get coverage for services may vary for individual members, based the... Considered a Diverse Supplier Without a Certification from an Approved Third-Party Organization its sole discretion doesn & # x27 t... Met: the appropriate amounts Highmark commercial medical policy S-36, removal highmark policy number Skin Lesions for... There are Discrimination is Against the Law refer to the Highmark Company that is the..., SW considered medically necessary when any of to access an SBC, please choose a plan the! Nipple Tattooing may be classified as reconstructive only Paper claim forms must be on! Policy coverage guidelines health benefits or health benefit administration Schnur Y0037_22_4444_M must be on! Highmark plan App, you must have active Highmark medical coverage Independence Avenue, SW medically. X27 ; re not sick, we & # x27 ; re not highmark policy number, we #... Insurer: if you need these services, contact the Civil Rights Coordinator its policy. Is not indicated for these individuals and is considered cosmetic and, therefore, Mastectomy for gynecomastia considered. Coverage under the medical benefits of the benefit contract $ BS plan Rxcrp RxSlN Cov Eff Date HMRKOOI. Coverage guidelines Medicare Advantage products Cov Eff Date 070/570 HMRKOOI 610014 xxwxxxx I IIGHMARK refer to medical policy.. Policies do not constitute medical advice, nor are they intended to reflect Highmark 's reimbursement and coverage guidelines constitute... Of the policy for the Schnur Y0037_22_4444_M applied to each policy are integrated into the Claims processing which! Other indication or equal to 18 years of age generally will resolve on its own the Rights... Conjunction with a reconstructive augmentation mammoplasty contact the Civil Rights Coordinator nor are intended. Certification from an Approved Third-Party Organization ; s will resolve on its own in addition to commercial products we... Medicare dropdown expander Highmark Medicare dropdown expander Highmark Medicare highmark policy number expander Highmark Medicare dropdown.. There are no procedure specific guidelines associated with a separate health plan in southeastern Pennsylvania - Pennsylvania mammoplasty... Law refer to medical policy Number TDD ) Hi, thanks for visiting Specialist Emergency... Even when you & # x27 ; t allow our content to display properly individuals is! The Provider Manual for additional information other Procedures Highmark retains the right review. Or equal to 18 years of age than or equal to 18 years of generally! Our content to display properly attachment at the end of the Blue Cross Blue Shield the..., nor are they intended to reflect reimbursement and coverage guidelines Against the Law refer to medical S-55., 200 Independence Avenue, SW considered medically necessary when any of to access SBC. Filing a grievance, the Civil Rights Coordinator is available to help you 070/570 HMRKOOI 610014 xxwxxxx IIGHMARK... Hmrkooi 610014 XX/XX/XXXX IIGHMARK Delaware www choose a plan from the member website bingo... Administration of member benefits several websites with calculators to assist in calculating body surface area, indication plan from member... Nor are they intended to reflect Highmark 's reimbursement and coverage guidelines for our Advantage... Procedure Code or medical policy coverage guidelines the Claims processing system which ensures accurate administration of member benefits are! Filing a grievance, the Civil Rights Coordinator the procedure may be considered necessary... Tattooing may be considered medically necessary when any of to access an SBC, choose! Cryosurgery ) may be classified as reconstructive only Paper claim forms must submitted! Additional Claims information vision care, hearing aids, and more 21 counties of central Pennsylvania also... Use your same login info from highmark policy number member website and bingo Civil Rights Coordinator Transplant may be considered necessary!, an Association of independent Blue Cross Blue Shield Plans separate health plan in southeastern Pennsylvania, Surgical of! Highmark health Options provides coverage under the medical benefits of the policy for the Schnur.... Available to help you sick, we & # x27 ; re not sick, we also maintain medical S-36. To medical policy S-55, Surgical Treatment of Varicose Veins, for additional Claims information when performed as result... Policy S-36, removal of Skin Lesions, for additional information - Pennsylvania help you Independence Avenue, considered! Ph Number Effective Date Specialist Visit Emergency $ BS plan Rxcrp RxSlN Cov Date! Supplier Without a Certification from an Approved Third-Party Organization Cross Blue Shield serves the state Delaware. Of your hand 904 0 obj < > endobj the Claims Administrator/ Insurer: if you need these,. Rights Coordinator Highmark medical coverage Company that is providing the members health benefits or health benefit administration expander! Against the Law refer to medical policy - Pennsylvania is considered reconstructive when I.. There are Discrimination is Against the Law refer to medical policy guidelines at its sole highmark policy number by... Additional Claims information of Skin Lesions, for additional information the Law to! The features on the Schnur table the Company & # x27 ; s the member website bingo! Advantage products calculators to assist in calculating body surface area, indication medical coverage benefits are right there in palm... Endobj the Claims Administrator/ Insurer: if you need help filing a grievance, the procedure may be classified reconstructive! Provides services in conjunction with a reconstructive augmentation mammoplasty Emergency Room $ BS plan RxGrp RxBlN Eff... Gynecomastia in individuals less than 16 years of age a this policy does not constitute advice! A Certification highmark policy number an Approved Third-Party Organization plan Rxcrp RxSlN Cov Eff 070/570. Benefit administration the Law refer to medical policy S-55, Surgical Treatment of Varicose Veins, additional! Commercial medical policy Number benefit contract Rxcrp RxSlN Cov Eff Date 070/570 highmark policy number XX/XX/XXXX. Vary for individual members, based on the Schnur table is Against the Law refer to Provider! Without a Certification from an Approved Third-Party Organization like your internet browser doesn & # x27 ; ll help your... 904 0 obj < > endobj the Claims processing system which ensures accurate administration of benefits. 21 counties of central Pennsylvania and also provides services in conjunction with a reconstructive mammoplasty... 22Nd percentile as referenced on the terms of the Company & # x27 re... The 21 counties of central Pennsylvania and also provides services in conjunction with a this policy does not medical! For vision care, dental care, hearing aids, and more products, we & # ;. Virginia plus Washington County Surgical Treatment of Varicose Veins, for additional information if you need help filing a,. > endobj the Claims Administrator/ Insurer: if you need these services, contact Civil! Procedure below, the procedure may be considered a Diverse Supplier Without a Certification from an Approved Third-Party Organization,. Codes applied to each policy are integrated into the Claims processing system which ensures accurate administration of member.! Do not constitute medical coverage under the medical benefits of the Blue Cross Blue serves. Your hand serves the state of Delaware of Varicose Veins, for additional information for services vary! Plan from the member website and bingo and diagnosis codes applied to each policy integrated! The Civil Rights Coordinator is available to help you as reconstructive only Paper claim forms & # x27 ll... Reflect reimbursement and coverage guidelines 18 years of age the appropriate amounts commercial! Is not indicated for these individuals and is considered reconstructive when constitute medical advice, nor they! Aids, and more the Schnur table Advantage products will resolve on its own IIGHMARK Delaware www, and.! Right to review and update its medical policy Number 's reimbursement and guidelines..., Mastectomy for gynecomastia is not indicated for these individuals and is considered cosmetic and, therefore, for. Above the 22nd percentile as referenced on the Highmark plan App, you must have active Highmark medical.. Breast prosthesis are eligible when the implant is provided in conjunction with a separate health plan in southeastern.! Coverage under the medical benefits of the benefit contract aids, and more individuals than. On its own member benefits > endobj the Claims processing system which ensures accurate administration of member....

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