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.Annual Update to Highmark’s Professional Fee Schedule & Pricing Methodology. 5/14/2024.Behavioral Health Resources. Behavioral Health Telemedicine and Virtual Visits. Enhanced Community Care Management Program. Laboratory Management Program. Musculoskeletal Surgery and Interventional Pain Management Services Prior Auth Program. Physical Medicine Management. Post-Acute Care Management For Medicare …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 ...New York providers in network prior to 8/1/2022 will be grandfathered for board certification and processed as routine. Initial providers beginning 8/1/2022, will need to be board certified, or meet one of the following exceptions: Completed training prior to December 31, 1987. Board Eligibility Period: Providers have 6 years post-residency or ...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.Provider Resource Center. Please access the Gateway Health Provider Portal via Navinet to determine if a drug/HCPCS code requires authorization and to submit authorization requests. View drug authorization requirements/submit authorization requests here: https://navinet.navimedix.com. Name.Annual Update to Highmark’s Professional Fee Schedule & Pricing Methodology. 5/14/2024.April 19, 2024. Chapter 2, Unit 6: The BlueCard Program. In 2.6 Itemized Bills Required for High-Dollar Host Claims, the amount considered a high-dollar claim was changed from "$100,000 or greater" to "$50,000 or greater.". In 2.6 NAIC Codes , changes were made to the PENNSYLVANIA NAIC CODE PROVIDER TYPE PRODUCTS table to align with ...Your session is about to expire! Click the button below to extend your session and stay logged in. You will be logged out after 5 more minutes of inactivity.April 19, 2024. Chapter 2, Unit 6: The BlueCard Program. In 2.6 Itemized Bills Required for High-Dollar Host Claims, the amount considered a high-dollar claim was changed from “$100,000 or greater” to “$50,000 or greater.”. In 2.6 NAIC Codes , changes were made to the PENNSYLVANIA NAIC CODE PROVIDER TYPE PRODUCTS table to align with ...Resources. Dealing with a health issue requires the right care and tools. Whether you are currently living with HIV, could be at risk for getting the virus, or are a care provider for a person impacted by HIV, Highmark Wholecare wants to help. Visit our HIV resource center to find local services, treatment options, and other resources.P.O. Box 279. Pittsburgh, PA 15230. OR. Fax the form to: 1-866-240-8123. OR. For expedited requests, phone 1-800-656-2485 to leave a message on the dedicated voice mail answering system. Your message should include all necessary information found on the request form.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.Provider data changes can be made by visiting the provider portal or by using the Provider Information Management Forms section of the Provider Resource Center. After you submit your form successfully, Highmark will retain an electronic copy of your CAQH ProView profile in its database and will send you a confirmation email.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 Wholecare providers are invited to use the 2024 Care Gap Management Application (CGMA). This application, live as of April 1st, supports Highmark Wholecare's mission to improve the health and wellness of the individuals and the communities we serve by offering providers access to important care gap information.Annual Update to Highmark's Professional Fee Schedule & Pricing Methodology. 5/14/2024.Obtaining Authorizations. Highmark requires authorization of certain services, procedures, inpatient level of care for elective/planned surgeries, and/or …Home Health/Home Infusion Therapy/Hospice: 888-567-5703. Inpatient Clinical: 800-416-9195. Medical Injectable Drugs: 833-581-1861. Musculoskeletal (eviCore): 800-540-2406. Telephone: For inquiries that cannot be handled via the online provider portal, call the appropriate Clinical Services number, which can be found here.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 communicate the ...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 Updates Tied to End of Public Health Emergency. On January 30, 2023, the federal government announced the expiration of the COVID-19 public health emergency (PHE), effective May 11, 2023.. In response to the COVID-19 pandemic and pandemic-related laws, Highmark implemented many policies and flexibilities waiving or requiring certain actions in response to the pandemic's effect on ...Following is the update to the Highmark Drug Formularies and pharmaceutical management procedures for October 2023. The formularies and pharmaceutical management procedures are updated on a bi-monthly basis, and the following changes reflect the decisions made in October by our Pharmacy and Therapeutics Committee.Additional information regarding the Quality Blue Hospital Program can be obtained by reviewing Chapter 5 of the Highmark Provider Manual. ... , then navigate to the Resource Center for all the information, including training and education, on these and other programs. Last updated on 10/26/2023 3:01:02 PM . To Top.This information is issued on behalf of Highmark Blue Shield and its affiliated Blue companies, which are independent licensees of the Blue Cross Blue Shield Association. ... see Highmark Delaware's online Provider Resource Center and access the . Pharmacy Program/Formularies. link for details on the formularies and formulary options that ...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 ...Some of the most significant natural resources of colonial Virginia included lumber, gold, tar, furs and iron. During the colonial period, Virginia was an important agricultural ce...Following is the update to the Highmark Drug Formularies and pharmaceutical management procedures for October 2023. The formularies and pharmaceutical management procedures are updated on a bi-monthly basis, and the following changes reflect the decisions made in October by our Pharmacy and Therapeutics Committee.Gastric Surgery/Therapy/Durable Medical Equipment/Outpatient Procedures: 888-236-6321. Home Health/Home Infusion Therapy/Hospice: 888-567-5703. Inpatient Clinical: 800-416-9195. Medical Injectable Drugs: 833-581-1861. Musculoskeletal (eviCore): 800-540-2406. Telephone: For inquiries that cannot be handled via the online provider portal, call ...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 ...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.These changes are announced in the form of Special eBulletins that are posted on Highmark's Provider Resource Center (PRC). The most recent eBulletins regarding prior authorization are below: Prior Authorization List to be Updated on July 1. Prior Authorizations No Longer Needed for Seven Injectables. Reminder: Prior Authorization Required ...First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield.Provider data changes can be made by visiting the provider portal or by using the Provider Information Management Forms section of the Provider Resource Center. After you submit your form successfully, Highmark will retain an electronic copy of your CAQH ProView profile in its database and will send you a confirmation email.First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield.New Address Change Form. As part of the No Surprises Act and Highmark's Provider Directory requirements, you must verify your information with Highmark every 90 days to remain in our directory. Highmark members looking for a provider will not have access to providers who are no longer listed in our directory. Beginning January 1, 2022 ...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 ...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. These guidelines address medical services, including diagnostic and therapeutic procedures, injectable drugs ...How Members Use the Home Delivery Service. Members can obtain home delivery forms for maintenance drugs by calling the Member Service telephone number on their ID card, or by calling MedcoHealth directly at: 1-800-903-6228. Once a member places an order, the member's information remains on file.Highmark Provider Form Regulations -Version 1.1 - 1/8/19 1. Assignment Account Regulations . I. Introduction . An assignment account is an account established by Highmark Blue Shield to permit one or more individual providers, practicing together, to direct Highmark Blue Shield payments to an entity other than the individual providers.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.How It Works. To access this new feature: Log into NaviNet and access Plan Central. Click the Case Management Referral and Inquiry link under Workflows for this Plan to go to the Clinical Care & Wellness page. Click the Create New Referral button under Submit New Referral to CC&W. Follow the steps to create and submit the referral.First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield.Annual Update to Highmark's Professional Fee Schedule & Pricing Methodology. 5/14/2024.WELCOME TO HIGHMARK! If you are a newly contracted provider, or a new employee of a network provider's office or facility, we would like to introduce you to the many resources we make available to help you in your interactions with Highmark and our members. Let's begin with some background on Highmark to help you get to know us: History of HighmarkMark Your Calendar for the 2024 Provider Fraud, Waste, and Abuse (FWA) Training. April 4, 2024. 12:00 PM - 1:00 PM. Speakers: Jennifer Putt, CFE Special Investigations Unit Manager, Highmark Wholecare. Michael Romito, CFE, MBA Special Investigations Unit Lead Investigator, Highmark Wholecare. Sandra Leisifer, CFE Special Investigations Unit ...In anticipation of an upcoming change in West Virginia Law (Senate Bill 267), Highmark is encouraging all providers to submit prior authorization requests electronically using our provider portal (either Availity ® or NaviNet ®). On December 1, 2023, Highmark removed prior authorization forms from the West Virginia Provider Resource Center …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.For other important news, information, and updates from Highmark BSNENY, be sure to read Provider News. ... "Read","description":"\u003cp\u003e\u003cem\u003eBecause the Highmark Blue Shield of Northeastern New York Provider Resource Center site was not yet live on August 30th when this Medical Policy Update was distributed, we\u0027ve provided ...Providers may provide information to Highmark to establish a rationale for not following the protocols. To request a review, submit a . Provider Pathways Reconsideration Request Form, which is available on the Highmark Provider Resource Center. Select . CARE MANAGEMENT PROGRAMS. from the main menu on the left, and then . Physical …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 ...Annual Update to Highmark’s Professional Fee Schedule & Pricing Methodology. 5/14/2024.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 ...Provider data changes can be made by visiting the provider portal or by using the Provider Information Management Forms section of the Provider Resource Center. After you submit your form successfully, Highmark will retain an electronic copy of your CAQH ProView profile in its database and will send you a confirmation email.Highmark Coding Tips is a periodic article that contains billing and coding best practices for professional and facility providers. Please refer to the Reimbursement Policy page for specific code edits used in Highmark's claims processing system. This publication focuses only on correct coding guidelines and tips to avoid common billing mistakes.Mark Your Calendar for the 2024 Provider Fraud, Waste, and Abuse (FWA) Training. April 4, 2024. 12:00 PM - 1:00 PM. Speakers: Jennifer Putt, CFE Special Investigations Unit Manager, Highmark Wholecare. Michael Romito, CFE, MBA Special Investigations Unit Lead Investigator, Highmark Wholecare. Sandra Leisifer, CFE Special Investigations Unit ...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 …Get to know Highmark's requirements for prior authorization and claims before performing a procedure or service. ... Get the information and resources you need in order to quickly and efficiently submit, update, and inquire about authorization requests. ... Provider Service Center. Can't find an answer? Call us: 8 a.m. to 5 p.m. EST, Monday .... Standard Rates for medical specialty drugs and injections are reiFor more information on using the Service Facility Location fiel Your session is about to expire! Click the button below to extend your session and stay logged in. You will be logged out after 5 more minutes of inactivity.Highmark Provider Manual. We have redesigned the Highmark Provider Manual to make it easier for you to view and find important information, policies, and procedures for all providers participating in our networks in Delaware, New York, Pennsylvania, and West Virginia. The Highmark Provider Manual is your primary reference guide to Highmark. If you experience any difficulties, please con First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield. Authorization Forms. Bariatric Surgery Precert...
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