Coverage profile
How Substrate can help you with Highmark Blue Cross Blue Shield (Western and Northeastern NY)
Substrate can help practices and billers with the following claims tasks for Highmark Blue Cross Blue Shield (Western and Northeastern NY).
Claim status
EDI 276/277The Substrate Claim Status Agent can check clearinghouse claim status for your practice with Highmark Blue Cross Blue Shield (Western and Northeastern NY).
Available
Eligibility
EDI 270/271The Substrate Eligibility Agent can verify patient benefits, identify TPAs and carve-outs, and more with Highmark Blue Cross Blue Shield (Western and Northeastern NY).
Available
Portal claim status
Browser automationThe Substrate Claim Status Agent can check claim status via the payer portal for Highmark Blue Cross Blue Shield (Western and Northeastern NY).
Available
2027 maternity billing research
When does Highmark Blue Cross Blue Shield (Western and Northeastern NY) change OB/GYN billing?
Confirmed 2027 guidance
This notice is limited to Highmark BCBS MMC, HARP, CHPlus and EP maternity services; it is not commercial or Medicare guidance. It states a January 1, 2027 CPT restructuring effective date and directs all NYS Medicaid-enrolled providers of the listed maternity services to use the restructured system for individuals initiating prenatal care on or after June 1, 2026 and/or having an estimated due date on or after January 1, 2027.
- Transition start
- Prenatal-care initiation cohort threshold; an estimated due date on or after January 1, 2027 is the alternative/additional criterion
- Billing start
- CPT restructuring effective date; separate claims-system cutover not specified
- Published
- 2026-07-01
- Current As Of
- August 2026
Scope: Only the medical maternity portion of this record corresponding to MMC, HARP, CHPlus or EP. This source does not establish commercial, Medicare, dental, vision or other Highmark-market implementation.
2027 maternity care coding restructuring. Verify the payer source before claim submission.
Frequently asked questions
Highmark Blue Cross Blue Shield (Western and Northeastern NY) payer FAQs
How do I check claim status with Highmark Blue Cross Blue Shield (Western and Northeastern NY)?
Providers check Highmark Blue Cross Blue Shield (Western and Northeastern NY) via EDI 276/277 when the payer ID is accepted. Substrate automates claim status across 3,500+ payers.
Can I automate Highmark Blue Cross Blue Shield (Western and Northeastern NY) portal follow-up?
Yes — portal retrieval is required when 276/277 is missing or stale. See payer portal automation and learn why 276/277 is not enough.
What is the payer ID for Highmark Blue Cross Blue Shield (Western and Northeastern NY)?
The primary payer ID for Highmark Blue Cross Blue Shield (Western and Northeastern NY) is 55204. The correct routing ID can differ by clearinghouse and transaction, so compare the 837P, 837I, 835, 270, and 276 entries before submitting.
What is the provider portal for Highmark Blue Cross Blue Shield (Western and Northeastern NY)?
The provider portal for Highmark Blue Cross Blue Shield (Western and Northeastern NY) is https://apps.availity.com/. Available features depend on the payer and your account.
What are the 837 payer IDs for Highmark Blue Cross Blue Shield (Western and Northeastern NY)?
The 837P and 837I payer ID for Highmark Blue Cross Blue Shield (Western and Northeastern NY) is 55204 via Stedi.
What is the 835 payer ID for Highmark Blue Cross Blue Shield (Western and Northeastern NY)?
The 835 payer ID for Highmark Blue Cross Blue Shield (Western and Northeastern NY) is 55204 via Stedi.
What is the 270 payer ID for Highmark Blue Cross Blue Shield (Western and Northeastern NY)?
The 270 payer IDs for Highmark Blue Cross Blue Shield (Western and Northeastern NY) are 55204 via Stedi and 10500 via Availity.
What is the 276 payer ID for Highmark Blue Cross Blue Shield (Western and Northeastern NY)?
The 276 payer ID for Highmark Blue Cross Blue Shield (Western and Northeastern NY) is 55204 via Stedi.
What state does Highmark Blue Cross Blue Shield (Western and Northeastern NY) operate in?
Highmark Blue Cross Blue Shield (Western and Northeastern NY) operates in NY.
Routing reference
Highmark Blue Cross Blue Shield (Western and Northeastern NY) payer IDs and operating states
Use the payer ID listed for the transaction you are submitting. Verify current routing and enrollment requirements with your clearinghouse.
| Payer name | Highmark Blue Cross Blue Shield (Western and Northeastern NY)Source: Substrate payer directory · last refreshed |
|---|---|
| Operating states | NYSource: Substrate payer directory · last refreshed |
| 837P professional claims payer IDStedi | 55204Enrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 837I institutional claims payer IDStedi | 55204Enrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 835 ERA payer IDStedi | 55204Enrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDStedi | 55204Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDAvaility | 10500Source: Availity payer catalog · catalog dated · matched by payer name |
| 276 claim status payer IDStedi | 55204Source: Stedi payer catalog · catalog dated · matched by payer ID |
Routing sources and verification
- Substrate payer directoryPayer identity, aliases, operating states, and vendor IDs. Last refreshed .Open payer website ↗
- Stedi payer catalogMatched by payer ID; matched record: Highmark Blue Cross Blue Shield (Western and Northeastern NY). Source dated .PrimaryPayerId is used as the transaction payer ID when the corresponding Stedi support flag is true.Open current Stedi reference ↗
- Availity payer catalogMatched by payer name; matched record: HEALTHNOW. Source dated .The attached API workbook supplies 270 and 276 payer IDs only. It does not supply 837P, 837I, or 835 IDs.Open current Availity reference ↗
- United Clearinghouse payer catalogMatched by payer name; matched record: Highmark Blue Cross Blue Shield (Western and Northeastern NY). The source did not provide a publication date.The attachment supplies payer names and states only; it does not contain transaction-specific payer IDs.Open current United Clearinghouse reference ↗
Clearinghouse payer IDs are transaction-specific and can change. Confirm the current payer list and the member’s ID card before submission.
Payer contact directory
Highmark Blue Cross Blue Shield (Western and Northeastern NY) phone and fax numbers
Use the number associated with your task. These contacts were stated in successful eligibility responses and may apply to specific benefits, products, or departments.
- Eligibility / benefits phone
- (800) 676-2583HIGHMARK BLUE CROSS BLUE SHIELD (WESTERN AND NORTHEASTERN NY
- Payer fax
(888) 282-1321HIGHMARK BLUE CROSS BLUE SHIELD (WESTERN AND NORTHEASTERN NY
| Channel and number | Payer Notes | Department | Specialties |
|---|---|---|---|
fax(800) 453-4341 | Other stated contextBenefit context: Co-Insurance |
| Hospital |
fax(833) 938-9934 | Other stated contextBenefit context: Co-Insurance |
| Hospital |
fax(844) 295-4637 | Other stated contextBenefit context: Co-Insurance |
| Hospital |
fax(866) 606-6021 | Other stated contextBenefit context: Coverage Basis |
| |
fax(877) 663-7526 | Other stated contextBenefit context: Co-Payment |
| Hospital |
fax(888) 282-1321 |
| ||
| phone(516) 794-7700 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Dental Care |
| phone(800) 255-5681 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Dental Care |
| phone(800) 321-0935 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Dental Care |
| phone(800) 441-9188 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Hospital, Hospital - Inpatient |
| phone(800) 450-8753 | Eligibility / benefits, Utilization managementBenefit context: Contact Following Entity for Eligibility or Benefit Information; Benefit context: Co-Payment |
| Hospital, Pharmacy |
| phone(800) 524-0149 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Dental Care |
| phone(800) 631-7780 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Pharmacy |
| phone(800) 676-2583 | Eligibility / benefits, Other stated contextBenefit context: Contact Following Entity for Eligibility or Benefit Information; Benefit context: Co-Insurance |
| Chiropractic, Chiropractic, Hospital, Hospital - Inpatient, Hospital - Outpatient, Professional (Physician) Visit - Office, Physician Visit - Office: Well, Health Benefit Plan Coverage, Hospital, Hospital - Inpatient, Professional (Physician) Visit - Office |
| phone(800) 972-4226 | Eligibility / benefits, Other stated contextBenefit context: Co-Payment; Benefit context: Contact Following Entity for Eligibility or Benefit Information |
| Chiropractic |
| phone(800) 972-8088 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Hospital, Hospital - Inpatient |
| phone(800) 981-3546 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Hospital, Hospital - Inpatient |
| phone(800) 987-8357 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Pharmacy |
| phone(833) 293-0659 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Pharmacy |
| phone(844) 770-1500 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Vision (Optometry) |
| phone(866) 343-3709 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Hospital, Hospital - Inpatient |
| phone(866) 819-4298 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Vision (Optometry) |
| phone(877) 241-7123 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Pharmacy |
| phone(877) 306-3093 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Pharmacy |
| phone(877) 718-2375 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Pharmacy |
| phone(888) 352-7924 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Dental Care |
| phone(800) 274-7767 | Utilization managementBenefit context: Co-Insurance |
| Hospital |
| phone(800) 305-4271 | Utilization managementBenefit context: Co-Insurance |
| Hospital |
| phone(800) 832-7850 | Utilization managementBenefit context: Co-Insurance |
| Hospital |
| phone(855) 343-4851 | Utilization managementBenefit context: Co-Insurance |
| Hospital |
| phone(866) 231-0847 | Utilization managementBenefit context: Co-Payment |
| Chiropractic |
| phone(866) 470-6244 | Utilization managementBenefit context: Co-Insurance |
| Hospital |
| phone(866) 678-7970 | Utilization managementBenefit context: Co-Insurance |
| Hospital, Hospital - Inpatient, Hospital - Outpatient |
| phone(877) 450-9355 | Utilization managementBenefit context: Co-Insurance |
| Hospital |
| phone(888) 235-4713 | Utilization managementBenefit context: Co-Insurance |
| Hospital |
| phone(888) 322-0928 | Utilization managementBenefit context: Co-Payment |
| Professional (Physician) Visit - Office |
| phone(951) 371-8440 | Utilization managementBenefit context: Limitations |
| Chiropractic |
| phone(800) 452-8507 | Behavioral health, Other stated contextBenefit context: Active Coverage |
| Hospital, Hospital - Outpatient, Hospital - Emergency Accident, Hospital - Emergency Medical, Mental Health, Hospital - Inpatient |
| phone(855) 339-8558 | Behavioral healthBenefit context: Active Coverage |
| Mental Health |
| phone(484) 862-3506 | Other stated contextBenefit context: Active Coverage |
| Hospital |
| phone(800) 344-5245 | Other stated contextBenefit context: Active - Pending Investigation |
| Hospital |
| phone(800) 351-2370 | Other stated contextBenefit context: Co-Insurance |
| Hospital |
| phone(800) 397-7337 | Other stated contextBenefit context: Co-Insurance; Benefit context: Co-Payment; Benefit context: Deductible |
| Hospital - Inpatient, Hospital - Outpatient |
| phone(800) 424-8270 | Other stated contextBenefit context: Coverage Basis |
| |
| phone(800) 480-6658 | Other stated contextBenefit context: Active Coverage |
| Hospital |
| phone(800) 541-6652 | Other stated contextBenefit context: Co-Insurance |
| Hospital |
| phone(800) 664-2583 | Other stated contextBenefit context: Active Coverage |
| Health Benefit Plan Coverage |
| phone(800) 780-7881 | Other stated contextBenefit context: Co-Insurance |
| Hospital |
| phone(800) 920-2485 | Other stated contextBenefit context: Active Coverage |
| Health Benefit Plan Coverage |
| phone(800) 922-8778 | Other stated contextBenefit context: Co-Insurance |
| Hospital |
| phone(800) 952-3404 | Other stated contextBenefit context: Co-Payment |
| Hospital |
| phone(833) 639-1634 | Other stated contextBenefit context: Co-Insurance |
| Hospital, Hospital - Inpatient |
| phone(833) 647-9355 | Other stated contextBenefit context: Co-Insurance |
| Hospital |
| phone(833) 663-8703 | Other stated contextBenefit context: Co-Insurance |
| Hospital |
| phone(855) 243-3326 | Other stated contextBenefit context: Co-Insurance; Benefit context: Co-Payment |
| Hospital - Inpatient, Hospital - Outpatient |
| phone(855) 288-8356 | Other stated contextBenefit context: Coverage Basis |
| |
| phone(855) 550-3733 | Other stated contextBenefit context: Active Coverage |
| Hospital |
| phone(866) 205-5107 | Other stated contextBenefit context: Coverage Basis |
| |
| phone(877) 599-2911 | Other stated contextBenefit context: Active Coverage |
| Hospital |
| phone(888) 849-3682 | Other stated contextBenefit context: Co-Payment |
| Hospital |
| phone(800) 214-4844 |
| ||
| phone(800) 327-6716 |
| ||
| phone(800) 727-2227 |
| ||
| phone(877) 444-2374 |
| ||
| phone(888) 233-8351 |
|
Phone and fax numbers sourced directly from the payer response
Other aliases
Also known as
- 10500
- 3536
- 55204
- 7485
- HLTNOW
- Z1093
- HealthNow Commercial
- HealthNow New York Incorporated
- Highmark Blue Cross Blue Shield (New York) - Commercial and Medicare Advantage
- Highmark Blue Cross Blue Shield (Western and Northeastern NY) - Medicare Advantage
- Highmark Blue Cross Blue Shield of Western New York
- Highmark Blue Shield (New York) - Commercial and Medicare Advantage
- Highmark Blue Shield of Northeastern New York
- Highmark Western and Northeastern New York
- HIGHMARK BLUE CROSS BLUE SHIELD (NY) - COMMERCIAL AND MA
- HEALTHNOW NEW YORK
- HEALTHNOW
- HIGHMARK BLUE SHIELD (NY) - COMMERCIAL AND MA