. Front of Card Back of Card Highmark Blue Cross Blue Shield Delaware is an independent licensee of the Blue Cross and Blue Shield Association . Wellness & Rewards Programs | Highmark Medicare Solutions Provider Resource Center To view the Highmark Medicare-Approved Select/Choice Formulary for Medicare Advantage or BlueRx members, click here. Your Health Care Partner | Highmark Sunosi Prior Authorization Form. SHOP. (i) when required or permitted by law or government agencies. If you are not satisfied with our data processing you have the right to lodge a complaint to the data protection authority in your country of residence. Short-Acting Opioid Prior Authorization Form. 0000001566 00000 n We do so by offering health plans that provide reliable coverage to Western New Yorkers and by supporting the organizations and individuals who work hard every day to keep our communities healthy. PDF See your prescription drug ID card. - Highmark Information on this website is issued by Highmark Blue Cross Blue Shield on behalf of these companies, which serve the 29 counties of western Pennsylvania and are independent licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross Blue Shield plans. 0000008906 00000 n 0000100729 00000 n Members may call the Member Services telephone number on their identification card to find out if they have home delivery coverage. 0000053581 00000 n Refill requests online, by mail, or by phone anytime, day or night. All FreedomBlue coverage includes at least the same services as those provided by Medicare. Physicians are requested to prescribe medications included in the formulary whenever possible. Wellness Debit Card - Gyms, Fitness Centers | Highmark BCBSWNY 0000018968 00000 n Call Highmark Member Service at the number on the back of your Highmark Member ID card, seven days a week from 8 a.m . This program may not be applicable to all members. *If you are aMedicaidorChild Health Plusmember, pleaselogin here. The Hi- Mark Bar 3229 Riverside Dr. Cincinnati, OH 45226 East End 513-492-7119 Order Carryout Order Delivery Wednesday Trivia 7pm / Hi- Mark Trivia hosted by Moichman Current Hours Last Updated 10:15am 6/7/2022 Outdoor Dining, Indoor Dining, Carryout and Delivery Monday-Thursday 4pm-11pm Friday 4pm-12am Saturday Noon-12am Sunday Noon-10pm. 0000008578 00000 n Highmark Blue Shield serves the 21 counties of central Pennsylvania and also . z g@t For anything else, call 1-800-241-5704. Your Highmark Wellness Rewards Prepaid Mastercard will be mailed directly to you following the processing of your claim. (i) when required or permitted by law or government agencies. 0000082377 00000 n Doctors and Drugs - Highmark These service providers will be bound by sufficient guarantees to implement appropriate technical and organizational measures in such a matter that their processing will meet the requirements of applicable law. (ii) when required valid requests by law enforcement. Eligibility, Usage, Activation, Products and Services. Patient ID Cards During the Highmark Affiliation - BCBSWNY 0000013562 00000 n The prescription drugs on this list are selected by a team of doctors and pharmacists and are updated on an on-going basis. W[=v@!&mbu+ XN_ [O>&A!X*&h}r~/P$"l~[GQvw4q6,J. Security | Privacy | Terms of Use | Notice of Non-Discrimination and Translation Assistance, Notice of Non-Discrimination and Translation Assistance, If this is your first time visiting, youll need to take a moment to register. To view the Highmark Select/Choice Formulary, click here. Download the latest version to access the site. Highmark's Medical and Pharmacy Affairs department monitors provider-specific formulary prescribing and communicates with providers to encourage use of formulary products. We will retain the information in our system in accordance with applicable law and our Data Protection Policy:https://www.highmark.com/hmk2/gdpr.shtml. The formulary is designed to assist in maintaining the quality of patient care and containing cost for the patient's drug benefit plan. 0000015345 00000 n PDF Anatomy Of An Identification Card - Highmark Blue Shield Highmark Health Insurance Company is a PDP plan with a Medicare contract. To obtain a copy of the formulary, contact your Provider Relations representative. Not subject to a deductible. 0000010006 00000 n 4. This committee is comprised of network physicians and pharmacists who select products on the basis of their safety, efficacy, quality and cost to the plan. Your email address and phone number may be used to contact you. You can contact them for any questions you may have regarding your condition, the specialty medication, and/or any side effects you may be experiencing. These ID cards will help you determine whether your patients have moved onto the new Highmark system, or if they are still on our current "legacy" BCBSWNY system. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. For members with a Highmark Medicare-Approved Select/Choice formulary benefit, non-formulary drugs are not covered under a Select formulary benefit or will require a higher co-payment under a Choice formulary benefit. Use this form to determine if a service or item requires prior authorization from the health plan before you receive care. Highmark's mission is to be the leading health and wellness company in the communities we serve. Your ID cards will come from our medical and dental vendors (i.e., Highmark Blue Cross Blue Shield and Cigna). 2. You also explicitly consent to the automated decision making by us, which may include the processing of your health data, to the extent that it is necessary to process your health claim swiftly and efficiently. For those members, the Express Scripts logo appears on the member's ID card. You must submit claims within 1 year of date of 0000004120 00000 n After that, all Personal Data will be deleted or the documents with such data will be anonymized. All reasonably appropriate measures will be taken to prevent disclosure of your Personal Data beyond the scope provided directly or indirectly herein or as may be reasonably inferred from the content contained in this notice or the website. 0000003041 00000 n For members with a Highmark Select or Highmark Choice formulary benefit, non-formulary drugs are not covered under a Select formulary benefit or will require a higher co-payment under a Choice formulary benefit. Notwithstanding the above disclosures, we will disclose the Personal Data we collect from you under the following circumstances: We use third-party service providers to process Personal Data, including, without limitation, for information storage and other similar purposes. |wx[en%L!Z300a`NNh0 )\ endstream endobj 475 0 obj 168 endobj 436 0 obj << /Type /Page /Parent 432 0 R /Resources << /ColorSpace << /CS2 437 0 R /CS3 442 0 R >> /ExtGState << /GS2 468 0 R /GS3 469 0 R >> /Font << /TT4 440 0 R /TT5 438 0 R /TT6 445 0 R /T1_1 453 0 R /TT7 452 0 R >> /ProcSet [ /PDF /Text ] >> /Contents [ 444 0 R 448 0 R 456 0 R 458 0 R 460 0 R 462 0 R 464 0 R 466 0 R ] /MediaBox [ 0 0 612 792 ] /CropBox [ 0 0 612 792 ] /Rotate 0 /StructParents 0 >> endobj 437 0 obj [ /ICCBased 471 0 R ] endobj 438 0 obj << /Type /Font /Subtype /TrueType /FirstChar 32 /LastChar 148 /Widths [ 250 0 0 0 0 0 0 180 333 333 0 564 250 333 250 278 500 500 500 500 500 500 500 500 500 500 278 278 0 0 0 0 0 722 667 667 722 611 556 722 722 333 0 0 611 889 722 722 556 722 667 556 611 722 722 944 722 722 611 0 0 0 0 0 0 444 500 444 500 444 333 500 500 278 278 500 278 778 500 500 500 500 333 389 278 500 500 722 500 500 444 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 333 444 444 ] /Encoding /WinAnsiEncoding /BaseFont /EADBCI+TimesNewRoman /FontDescriptor 439 0 R >> endobj 439 0 obj << /Type /FontDescriptor /Ascent 891 /CapHeight 656 /Descent -216 /Flags 34 /FontBBox [ -568 -307 2028 1007 ] /FontName /EADBCI+TimesNewRoman /ItalicAngle 0 /StemV 94 /XHeight 0 /FontFile2 467 0 R >> endobj 440 0 obj << /Type /Font /Subtype /TrueType /FirstChar 32 /LastChar 174 /Widths [ 250 0 0 0 0 0 0 0 333 333 0 0 250 333 250 278 500 500 500 500 500 500 500 500 500 500 0 0 0 0 0 500 0 722 667 722 722 667 611 0 778 389 0 0 667 944 0 778 611 778 0 556 667 722 0 1000 0 0 0 0 0 0 0 0 0 500 556 444 556 444 333 500 556 278 0 556 278 833 556 500 556 556 444 389 333 556 500 722 500 500 444 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 333 500 500 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 747 ] /Encoding /WinAnsiEncoding /BaseFont /EADBEJ+TimesNewRoman,Bold /FontDescriptor 441 0 R >> endobj 441 0 obj << /Type /FontDescriptor /Ascent 891 /CapHeight 656 /Descent -216 /Flags 34 /FontBBox [ -558 -307 2034 1026 ] /FontName /EADBEJ+TimesNewRoman,Bold /ItalicAngle 0 /StemV 160 /XHeight 0 /FontFile2 470 0 R >> endobj 442 0 obj /DeviceGray endobj 443 0 obj 1793 endobj 444 0 obj << /Filter /FlateDecode /Length 443 0 R >> stream Wellness Debit Card - Balance, Vendors, Locations - BCBSWNY Last updated on 10/24/2022 10:44:11 AM. 0000020754 00000 n bcbs highmark prior authorization form For some plans with a mandatory generic provision, if a member requests the brand name drug, but the prescription does not specify "brand medically necessary," the member will be required to pay the difference in cost between the brand drug and the generic drug, in addition to the applicable brand name copayment. 0000004173 00000 n Networks and drug benefits may vary slightly, depending upon the member's group and/or managed care program. Pharmacies have point-of-sale technology that confirms a member's eligibility, benefit design and copayment information at the time of dispensing. Name of the subscriber - the individual under whose name the coverage Specialty Drug Request Form. Home page [www.highmarkblueshield.com] The member can send the other prescription to the home delivery service for up to a 90-day supply. All fields are required. This program may not be applicable to all members. Always present your prescription drug ID card at the participating retail pharmacy. 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 Blue Cross Blue Shield of Western New York | Home Highmark Health Insurance Company is a PDP plan with a Medicare contract. 0000002426 00000 n 0000053660 00000 n Additionally, Accredo has specialized pharmacists who know and understand your conditions. 3. 0000006499 00000 n You now have one card for both your medical and prescription benefits. HWMo7WB! . 2. For more information, please refer to Chapter 3, Unit 5 of the Office Manual. (It is recommended that this prescription be written for a two-week supply.) Coverage for Some Over-the-Counter DrugsSome over-the-counter medications are available through the closed formulary. Provider Resource Center Highmark ID Cards - GuideStone Mail order savings may not apply to all plans. Your Personal Data will remain on file for: any period required by applicable law; and, to the extent necessary for any purpose(s) provided directly or indirectly herein or as may be reasonably inferred from the content contained in this notice or the website, but no longer than permitted by applicable law. I am a: Member / Patient Provider Member Group Number The member group number is located on the Blue Cross and Blue Shield of Minnesota member ID card. 0000017131 00000 n The purpose of this Data Protection Statement is to notify you of the practices that will govern the processing of your personal data and to obtain your explicit consent for the processing of your personal data consistent with it, in particular in accordance with the legal requirements of the European Unions (EU) General Data Protection Regulation (GDPR): The personal data collected may include your address, city, postal code, country, phone number, email address, IP address, as well as any other personal information you choose to provide (Personal Data). null - Highmark Blue Shield Find a Prescription Drug | Highmark Medicare Solutions Accredo will mail your specialty medications to your home or another secure location. This website works best with Internet Explorer 7 and above or Firefox 2.0 and above. or If you have questions regarding how we process your Personal Data and what we store about you, please contact PrivacyInternational@HighmarkHealth.org or write us: By agreeing to the terms and conditions set out in this Data Protection Statement, and by providing us with your Personal Data, you consent to the collection, use and disclosure of any information you provide in accordance with the above purposes and this Data Protection Statement. A prescription is required for these drugs and the member must obtain the medication through the pharmacy for coverage to apply. @ Dependent and PCP Information , if applicable 4. If you have questions regarding how we process your Personal Data and what we store about you, please contact PrivacyInternational@HighmarkHealth.org or write us: By agreeing to the terms and conditions set out in this Data Protection Statement, and by providing us with your Personal Data, you consent to the collection, use and disclosure of any information you provide in accordance with the above purposes and this Data Protection Statement. Do not use this mailing address or form for provider inquiries. Highmark Blue Cross Blue Shield Delaware administers prescription benefits for almost all members. Need Help? 0000001979 00000 n Have your Member ID card handy. For those members, the MedcoHealth logo appears on the member's ID card. Drugs are listed by brand and generic names. (iii) for purposes relevant to corporate policies or litigation to the extent permitted under applicable law or when it is prescribed in GDPR or other applicable law. Once Highmark Blue Shield receives a claim, it will electronically route the claim to the member's Blue Plan. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. If you have any questions about home delivery from the Express Scripts Pharmacy or your prescription benefit, please call the number on the back of your member ID card. Home delivery service is an option that groups may select depending on their benefit design. Enrollment in Highmark Choice Company, Highmark Senior Health Company, Highmark Senior Solutions Company, Highmark BCBSD Inc., Highmark Western New York and Northeastern New York Inc. and Highmark Health Insurance Company depends on contract renewal. Our phone number is on your member ID card. Rx pcn number blue cross - iwacrk.picotrack.info General Information about Pharmacy Benefits, http://highmark.medicare-approvedformularies.com. The main identifiers for BlueCard members are the alpha prefix, a blank suitcase logo, and, for eligible PPO members, the "PPO in a suitcase" logo. Provider Resource Center We want to clarify these ID card changes for you so you can best . . 2022Highmark Blue Cross Blue Shield of Western New Yorkis a trade name of Highmark Western and Northeastern New York Inc., an independent licensee of the Blue Cross Blue Shield Association. Hb```f``[9A@l(GwF\ VbqIBL230[1c43? Read each plan summary carefully a drug's formulary status may affect how much you pay. Advantages of Using the Home Delivery ServiceMembers may prefer to use the home delivery prescription service. 0000003271 00000 n Weight Loss Medication Request Form. Members may call the Member Services telephone number on their identification card to find out if they have home delivery coverage. The How to Assist Members in Using the Home Delivery ServiceIf a member must begin taking a new maintenance drug immediately, they may need to have two prescriptions. You must complete a separate claim form for each pharmacy used and for each patient. 0000002467 00000 n After that, all Personal Data will be deleted or the documents with such data will be anonymized. Mail-order Benefits. Non-individual members Sign in to Availity to submit prior authorizations and check codes. 0000013585 00000 n Sign up for highmark otc store - aqgtrr.kalles-kartenchaos.de If you have questions about Medi-Cal Rx , call the Medi-Cal Member Help Line at (800) 541-5555 [TTY: (800) 430-7077], Monday through Friday, 8 a.m. to 5 p.m. We will retain the information in our system in accordance with applicable law and our Data Protection Policy:https://www.highmark.com/hmk2/gdpr.shtml. 0000001704 00000 n The drug formulary is divided into sections based on the member's plan benefit design. Get care for your physical and mental well-being, including prescription drug coveragefrom the doctors, hospitals, and pharmacies you need. 3. (Members receive a directory of pharmacies with their enrollment materials.) These service providers will be bound by sufficient guarantees to implement appropriate technical and organizational measures in such a matter that their processing will meet the requirements of applicable law. 0000002001 00000 n Notes: This consent is given voluntarily and can be revoked at any time in writing by sending an email to PrivacyInternational@HighmarkHealth.org If you want to exert your withdrawal right or your rights to access, rectify, block, transfer or delete your personal data pursuant to the GDPR, please contact us and provide us at least with your full name, address and the data processing you are inquiring about. Highmark Spending Accounts Highmark is not responsible for lost or stolen cards. Notes: This consent is given voluntarily and can be revoked at any time in writing by sending an email to PrivacyInternational@HighmarkHealth.org If you want to exert your withdrawal right or your rights to access, rectify, block, transfer or delete your personal data pursuant to the GDPR, please contact us and provide us at least with your full name, address and the data processing you are inquiring about. Request ID Card - Highmark Blue Cross Blue Shield 0000009156 00000 n Most dosage forms and strengths of a drug are included in the formulary. Notwithstanding the above disclosures, we will disclose the Personal Data we collect from you under the following circumstances: We use third-party service providers to process Personal Data, including, without limitation, for information storage and other similar purposes. Select Language; Select Language Even when you're not sick, we'll help with your wellness goals. Testosterone Product Prior Authorization Form. Got a Question? Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Please consult your plan documents for details. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. Rx group number and pharmacy logo -This will be on the ID card whenever a Highmark prescription drug program is included. Language Assistance. Reporting Fraud. The following outlets do not participate in our wellness debit card program: Pharmacies, sporting goods stores, grocery stores, doctor's offices, optometrists, salons, and department stores. Up to a 90-day supply of each covered medication (compare to a typical retail 30-day supply) Online refill reminders. Over the next few months, we will begin issuing new Highmark ID cards to your patients. 0000085055 00000 n Your Personal Data will be disclosed to appropriate personnel for purposes of performing services to, or on behalf of, our enterprise customers and prospective customers as part of and in relation to matters regarding our provider, health plan, and subsidiary enterprise care delivery, administration and operations. That list will vary depending on the plan you choose. Forgot Password, Whether you fill your prescriptions at a local pharmacy or have them delivered, our tool helps you select the lowest-cost pharmacy, identify lower-cost alternatives, and compare brand-name and generic costs.1, You can save both time and money with mail-order prescriptions through the Express Scripts home-delivery program. The member is charged the generic copayment. Leading health and Wellness company in the communities we serve from highmark bcbs prescription card plan... 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