Introducing a new provider resource experience that simplifies getting you the information you need, when you need it. You're invited to visit an early release of our new site; try it out at providers.highmark.com.Your feedback is appreciated as we work to complete the experience.Provider Resource Center until the effective date, Oct. 1, 2018. CODES TO BE DELETED FROM AUTHORIZATION LIST, EFFECTIVE OCT. 1, 2018 . Effective Oct. 1, 2018, Highmark will delete approximately 300 codes from its . List of Procedures/DME Requiring Authorization. Click here to view a list of these codes. Note:The 2024 Preventive Health Guidelines are now available on the Provider Resource Center. Every year, Highmark and participating network physicians review and update the Preventive Health Guidelines, which are made available to the practitioner community as a reference tool to encourage and assist you in planning your patients’ care.Provider Directory. Site Map. Legal Information. The following entities, which serve the noted regions, are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc ...Provider Directory. Site Map. Legal Information. The following entities, which serve the noted regions, are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc ...Behavioral Health Practice Resources. Behavioral Health-specific sample treatment records, sample policies, and sample office forms and protocols intended for use to assist in office site evaluations and treatment record documentation compliance. Sample Treatment Record Resources. Behavioral Health Progress Note. Behavioral Health Treatment Plan.2023 NEW DSNP Member Benefits- Notice and Resource Guide. Oct 2022. 2023 DSNP Member Benefits - Detail. Oct 2022. Provider Webinar: 2023 Medicare Assured D-SNP. Oct 2022. Medications to Require Medical Prior Authorization, Effective Nov 1. Oct 2022. Notice of Medicare Policy Updates for Nov 1.On this page, you will find some recommended forms that providers may use when communicating with Highmark, its members or other providers in the network. Assignment of Major Medical Claim Form. Authorization for Behavioral Health Providers to Release Medical Information. Discharge Notification Form. Expanded Provider Directory - Group.used to request an extension in the time allotted for care. (This form is also available on the Physical Medicine Management Program page of the Provider Resource Center, under CARE MANAGEMENT PROGRAMS). Complete the appropriate section of the form and fax the form to WholeHealth Living at fax# 1-888-492-1029.Call the Provider Service Center for your region. Enter the provider's NPI number. Enter the member's Highmark ID or social security number. Enter or say the member's birthdate. Say "Authorization.". Say "Check Status" press "1.". Enter authorization reference number (skipping any letters or symbols).Annual Update to Highmark's Professional Fee Schedule & Pricing Methodology. 5/14/2024.Availity Essentials: Introduction for Highmark Providers. Applications covered: General Navigation, Eligibility and Benefits Inquiry, Manage My Organization, Payer Spaces, and Authorizations. ... As more information becomes available about the status of Risk Manager, we will share that with you via the Provider Resource Center and Availity portal.Highmark’s Provider Resource Center (PRC) – the main hub for important information, including policies, procedures, the Highmark Provider Manual, and Provider News. …Highmark will also post communications here on the Provider Resource Center, and Availity may announce new features and training opportunities on their in-portal message center. For Help. For Availity Client Services assistance, call 1-800-AVAILITY (282-4548) or, within the Availity portal, click Help & Training and then click on Availity Support.Highmark will also post communications here on the Provider Resource Center, and Availity may announce new features and training opportunities on their in-portal message center. For Help. For Availity Client Services assistance, call 1-800-AVAILITY (282-4548) or, within the Availity portal, click Help & Training and then click on Availity Support.Provider Manual. The provider manual is reviewed in detail by a provider relations representative with the provider within 30 calendar days of the provider successfully gaining approval to participate in the Highmark Wholecare network. The provider manual includes information regarding EPSDT requirements such as Blood …Attached please find the following documents to help you start the credentialing process: Initial Application for Facility and Ancillary Providers. Organizational Provider Participation, Credentialing, and Contracting Requirements. Highmark Provider Manual Chapter 3, Unit 4. Urgent Care Center/Medical Aid Unit and Retail Clinic Application.Assistance for Highmark Participating Providers Impacted by Change Healthcare Cyber Event. 3/11/2024.Highmark is pleased to announce that over 10,900 new clinicians have qualified for our expedited prior authorization program, known as the Gold Card Program, which provides streamlined approval for select services.Qualification to the program is a recognition of each provider practice or individual clinician's adherence to evidence-based guidelines and appropriate care.If a prior authorization is required, please submit the information below to the Highmark Prior Authorization Department by faxing to 1-866-240-8123. Member name, DOB, ID#. Drug, strength, quantity requested. Diagnosis, alternatives tried. Other pertinent clinical information (to view the criteria, please access our pharmacy clinical policies ...Highmark's Provider Resource Center (PRC): You are here! The PRC is the main hub for you and your staff to review important information and tools, such as EFT registration, policies, procedures, and the Provider Manual. Availity Essentials, Highmark's Provider Portal: The primary method to submit transactions to Highmark and access reports:Quick Claims Functionality in Availity Now Available for Highmark Providers. 4/17/2024.Organizational Credentialing Forms. Recredentialing Application for Facility and Ancillary Providers. If you have recently received a letter stating that you must recredential, please use this form to enter the requested information. Change of Ownership (CHOW) Form. Please use this form to report any changes in ownership which may include the ...Highmark's Kidney Health Management (KHM) program (Powered by Healthmap) uses advanced analytics to identify and support patients diagnosed with chronic kidney disease (CKD) or end stage renal disease (ESRD) that may benefit from additional care intervention. To learn more about the program, you can read our provider handout or view the video ...Behavioral Health: 833-581-1866. Gastric Surgery: 833-619-5745. Durable Medical Equipment/Medical Injectable Drugs/Outpatient Procedures: 833-619-5745. Inpatient Clinical: 833-581-1868. Telephone: For inquiries that cannot be handled via the online provider portal, call the appropriate Clinical Services number, which can be found here.Our mission is to: Ensure all Highmark members receive the right care, at the right place, at the right time. . Reduce overuse of services that expose members to unnecessary risk or cost where there is no net clinical benefit. Promote increased use of proactive, preventative, and conservative therapies that result in better outcomes.Chapter 3, Unit 2: Professional Provider Credentialing. In 3.2 Highmark Network Credentialing Policy, the ADVANCED PRACTICE PROVIDER (APP) ENUMERATION section was updated to point providers to Reimbursement Policy 068 (RP-068): Mid-Level Practitioners and Advanced Practice Providers for more information instead of Reimbursement Policy 010 (RP ...If you must submit a telephonic request, call the appropriate phone number below to reach Medical Management & Policy: Western Region: 1-800-547-3627. Central, Eastern and Northeastern Regions: 1-866-731-8080. For Medicare Advantage Members, call: FreedomBlue PPO: 1-866-588-6967. Medicare Advantage HMO: 1-866-517-8585.For more information on using the Service Facility Location field on claims, see the Highmark Provider Manual: Chapter 6, Unit 1: General Claim Submission Guidelines > Service Field Location. To access the Provider Manual, go to the Provider Resource Center, select MANUALS from the taskbar, and click HIGHMARK PROVIDER MANUAL from the dropdown.Based on feedback from providers and their teams, we put together these tips to help providers and their teams complete transactions in Availity ® easier and faster: 1. Use …Highmark Provider Manual Tip Sheet Index. This page is intended to be a collection of all tip sheets embedded throughout the units of the Highmark Provider Manual. These easy-to-use, printable documents provide relevant information and practical tips for many Highmark procedures. Highmark has incorporated this feature in response to provider needs.To request prior approval or obtain a list of drugs and supplies that require prior approval, call CVS Caremark (FEP's pharmacy program administrator) at 877-727-3784 from 7:00AM to 9:00PM. Providers may submit prior approval drug requests securely online.Highmark's Provider Resource Center Home Page has a new look to make it easier for health care professionals, facilities, and staff to find the latest news and updates. Special Bulletins are now front-and-center on the homepage allowing easy access to some of the most recent changes and communications. Our latest Provider News and Medical ...For additional details on eligibility criteria and how the program works, please see our Gold Card Program page on the Provider Resource Center. Launched in 2022, Highmark's Gold Card Program has experienced considerable growth — with over 17,000 providers currently enrolled.Highmark’s Provider Resource Center (PRC) – the main hub for important information, including policies, procedures, the Highmark Provider Manual, and Provider News. …Call 1-855-284-2494 (TTY: 724-631-5600) Find help with bills, housing, after-school programs and more. You may also dial 2-1-1 or text your zip code to 898-211. Calls/texts are answered 24/7. National Alliance on Mental Illness (NAMI) Helpline: Talk to a trained crisis staff who understands and can help.Our mailing address is: Highmark Fifth Avenue Place 120 Fifth Avenue Pittsburgh, PA 15222-3099 (412) 544-7000 (TTY/TDD: 711)The following entities serve central and southeastern Pennsylvania and are independent licensees of the Blue Cross Blue Shield Association: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company.Chapter 3, Unit 2: Professional Provider Credentialing. In 3.2 Highmark Network Credentialing Policy, the ADVANCED PRACTICE PROVIDER (APP) ENUMERATION section was updated to point providers to Reimbursement Policy 068 (RP-068): Mid-Level Practitioners and Advanced Practice Providers for more information instead of Reimbursement Policy 010 (RP ...The following entities, which serve the noted regions, are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc.,Our mailing address is: Highmark Fifth Avenue Place 120 Fifth Avenue Pittsburgh, PA 15222-3099 (412) 544-7000 (TTY/TDD: 711)Learn More About the Advanced Imaging and Cardiology Services Program. eviCore has a dedicated webpage for Highmark providers to conveniently access evidence-based clinical guidelines, the current CPT code list, important resources and recent announcements. We encourage you to visit their site to ensure that you have the most current information.Attached please find the following documents to help you start the credentialing process: Behavioral Health Application For Organizational Providers - This application is to be used by Organizational Providers only. Professional providers should select Credentialing on the left navigation bar, then Professional Initial Credentialing Set Up ...Initial applicants for the Delaware Medicaid network must submit a copy of the DMAP Provider Enrollment Application approval letter. 8. New York network credentialing requirements effective 8/1/2022. 9. New York-If the license requirement is a tax certificate, the certificate is valid for all locations. Organizational Provider Type. State/LOB.But if you need to contact us, below are the telephone numbers exclusively for providers. HIGHMARK 1-800-547-3627. Convenient self-service prompts available. 1-866-588-6967 — Freedom Blue SM PPO Provider Service Center. 1-866-675-8635 — Freedom Blue PFFS Provider Service Center. 1-888-234-5374 — Community Blue Medicare HMO Provider ...A1: For retrospective review requests submitted on or after December 4, 2023, providers are encouraged to utilize the Provider Portal (Availity). If the request falls outside of the Provider Portal acceptance threshold, providers can contact Utilization Management at 1-800-452-8507.Highmark Health continues layoffs, cuts nearly 100 positions. The Highmark sign is seen at the top of Fifth Avenue Place, Wednesday, July 26, 2017, in Pittsburgh. (AP Photo/Keith Srakocic ...Introducing a new provider resource experience that simplifies getting you the information you need, when you need it. You're invited to visit an early release of our new site; try it out at providers.highmark.com.Your feedback is appreciated as we work to complete the experience.Provider Directory. Site Map. Legal Information. The following entities, which serve the noted regions, are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark …Tool and Resources – The Provider Resource Center (PRC) is the central location for helpful information such as: The Highmark Provider Manual. BlueCard (Chapter 2, Unit 6) Fraud Prevention (Chapter 6, Unit 8) Important Announcements and Updates. Prior Authorization Requirements.Introducing a new provider resource experience that simplifies getting you the information you need, when you need it. ... Message Center. Manuals . Highmark Provider Manual; ... Quick Claims Functionality in Availity Now Available for Highmark Providers. 4/17/2024. National Infant Immunization Week is April 22-29.Tool and Resources – The Provider Resource Center (PRC) is the central location for helpful information such as: The Highmark Provider Manual. BlueCard (Chapter 2, Unit 6) Fraud Prevention (Chapter 6, Unit 8) Important Announcements and Updates. Prior Authorization Requirements.COVID-19. COVID-19 (Coronavirus) Information; Telemedicine Webinar; Telemedicine and Virtual Visits; No Surprises Act. No Surprises Act; Authorizations. Authorization FormsNote: The specialty tier does not apply to Highmark Delaware Healthcare Reform members; see Highmark Delaware’s online Provider Resource Center and access the . Pharmacy Program/Formularies. link for details on the formularies and formulary options that apply to Highmark Delaware Healthcare Reform members.Behavioral Health Fax Number for Authorization Requests: 1-877-650-6112. For precertification or continued stay review requests for Behavioral Health treatment, please submit relevant clinical information via fax to 1-877-650-6112. Submission of the complete medical record may slow down the process and is not an efficient way to …Enter Service Information. Select the Sub-service dropdown. For Chiropractic, choose Chiropractic. Sub-service types will show relevant procedure codes that are included in the Sub-service type. Select Add to add the Sub-service type. Click Submit at bottom right when all applicable selections are made.The full fee schedule is available on the Provider Resource Center. Access by signing into Availity > Payer Spaces > Highmark > Provider Resource Center. Attachment size currently allows for a total 45MB for 1 – 10 attachments. Allow for attachment total size of 100MB for 1 – 10 attachments.Call the Provider Service Center for your region. Enter the provider's NPI number. Enter the member's Highmark ID or social security number. Enter or say the member's birthdate. Say "Authorization.". Say "Check Status" press "1.". Enter authorization reference number (skipping any letters or symbols).Provider Directory. Site Map. Legal Information. The following entities, which serve the noted regions, are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc ...Highmark Blue Shield welcomes newly contracted providers in Southeastern Pennsylvania. To help you get acquainted with working together, we offer tools and resources through our Provider Resource Center (PRC). The Highmark PRC is the central location for helpful information such as: The Highmark Provider Manual. …Highmark Wholecare is aware of a cyber security incident impacting Change Healthcare - an outside vendor that supports health care providers and vendors with electronic submissions to payers such as the filling of prescriptions and health care claims. This is a widespread disruption affecting health care providers and some pharmacies nationwide.The full fee schedule is available on the Provider Resource Center. Access by signing into Availity > Payer Spaces > Highmark > Provider Resource Center. March 16, 2024. CLOSED. Secure Messaging. Attachment size currently allows for a total 45MB for 1 – 10 attachments.Organizational Credentialing Forms. Recredentialing Application for Facility and Ancillary Providers. If you have recently received a letter stating that you must recredential, please use this form to enter the requested information. Change of Ownership (CHOW) Form. Please use this form to report any changes in ownership which may include the ...Highmark Provider Manual ... Message Center. Manuals . Highmark Provider Manual; ... Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life or Highmark .... Learn More About the Advanced Imaging and Cardiology SerBehavioral Health Toolkit for Primary Care Physicians. Highmark Heal 2024 Preventive Health Guidelines. Prenatal/Perinatal Guidelines. Children Ages 0-6 Guidelines. Children Ages 7-18 Guidelines. Adult Ages 19-64 Guidelines. Adult 65 and Older Guidelines. Women's Preventive Health Services Addendum. Perinatal Depression Prevention Counseling Coding Guidelines. PrEP Related Services Coding Guidelines.Highmark has incorporated MCG Health evidence-based clinical guidelines into our criteria of clinical decision support, replacing Change Healthcare ... Imaging: These are presently managed by eviCore which uses their own medical policy (policies are available on Highmark's Provider Resource Center). The Medical Policy Department, in collaboration with physici Highmark will also post communications here on the Provider Resource Center, and Availity may announce new features and training opportunities on their in-portal message center. For Help. For Availity Client Services assistance, call 1-800-AVAILITY (282-4548) or, within the Availity portal, click Help & Training and then click on Availity Support.Highmark's Provider Resource Center. More information about the end-to-end authorization process, including workflow guides, may be found on our Provider Resource Center (PRC). Look under AUTHORIZATIONS > Procedures/Service Requiring Authorization. You will also find details regarding the Availity transition on the PRC. If you haven't already done so, follow these simple steps to...
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