For 2023, Highmark's Preventive Health Guidelines feature these changes: Nutritional counseling for Obesity Prevention in midlife women, ages 40 to 60 years old, with normal body mass index (BMI) and overweight BMI. Explanation: Women's Preventive Services Initiative recommends counseling midlife women with normal or overweight BMI (18.5-29 ...Highmark continually seeks ways to make its network credentialing process easier for our providers. We are required by federal law and the American Accreditation HealthCare Commission to initially credential providers who participate in Highmark's preferred provider networks and in Highmark's Medicare Advantage network.This program supports Highmark Wholecare's mission to improve the health and wellness of the individuals and the communities we serve by providing access to integrated, superior health care. 2024 Program Overview. Providers must opt-in to the program (either/both the Highmark Wholecare Practitioner Excellence (HWPE) Program and the Maternity ...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.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 ...Authorization Forms. Bariatric Surgery Precertification Worksheet. Behavioral Health (Outpatient - ABA) Service Authorization Request. Home Health Precertification Worksheet. Inpatient and Outpatient Authorization Request Form. Pharmacy Prior Authoriziation Forms. Last updated on 12/19/2023 10:06:35 AM.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 …To ensure delivery of emails from Highmark, please add the following email address, [email protected], to your address book. 1. Enter Email Address:*. (Enter Group/Vendor or Practitioner's e-mail address. The same e-mail address cannot be repeated for another Group/Vendor or Practitioner). Email Address: 2.The Essential Formulary is a closed formulary for select Healthcare Reform (HCR) Individual plans. A list of drugs included on the Essential Formulary, listed by therapeutic class, is available here. All formulary changes effective August 2023, unless otherwise noted. Table 1. Formulary Updates.COVID-19. COVID-19 (Coronavirus) Information; Telemedicine Webinar; Telemedicine and Virtual Visits; No Surprises Act. No Surprises Act; Authorizations. Authorization FormsUnder Provider Sign In, enter your username and password if registered, or select register now. Enter your CAQH Provider ID. (If you don't know it, call CAQH at 1-888-599-1771). Enter or update your information. Authorize Highmark BCBSWNY to access your information electronically.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.A list of United Medical Resources insurance providers is available online at UMR.com, according to the company’s website. Click on the Find a Provider link located near the left c...But if you need to contact us, below are the telephone numbers exclusively for providers. HIGHMARK. 1-866-731-8080. 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. 1-866-634-6468 — Requests for Medical Management and Policy ...The High Performing Provider (HPP) designation is replacing the former Pathways Program effective January 1, 2025, for providers in all Highmark service areas. It is designed to give Highmark a formal process and framework for identifying and rewarding high-performing providers based on a defined set of metrics, allowing qualifying providers to ...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 ...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.This information is issued on behalf of Highmark Blue Shield and its affiliated Blue companies, which are independent license es of the Blue Cross Blue Shield ... 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 toHighmark 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.The Conservation Channel provides information on some of the major issues in the field of nature conservation. Check out the Conservation Channel. Advertisement Conservation is a g...Annual Update to Highmark's Professional Fee Schedule & Pricing Methodology. 5/14/2024.Please use 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.Please refer appropriate patients to ECCM through any of these channels: Phone Number: 844-438-3226 (844-GET-ECCM) Email: [email protected]. Fax: 844-978-2756. Care Port. Highmark HHUM Portal. ECCM Referral Form. Last updated on 6/3/2022 3:16:12 PM.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.Step 1: Highmark Training. Step 2: Medicare Parts C and D General Compliance Training. Step 3: Combating Medicare Parts C and D Fraud, Waste and Abuse. Step 4: Training Attestation. Once you meet the program requirements, an authorized representative of your organization can complete and retain a copy of the attestation form above for your records.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. West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield ...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.But if you need to contact us, below are the telephone numbers exclusively for providers. HIGHMARK. 1-866-731-8080. 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. 1-866-634-6468 — Requests for Medical Management and Policy ...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.Formulary Updates. The Highmark Drug Formulary is a list of FDA-approved prescription drug medications reviewed by our Pharmacy and Therapeutics (P&T) Committee. 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.This means you don’t have to retype data, such as NPI numbers or provider names. Access to Highmark-specific resources through a dedicated payer space. Which Highmark plans will I be able to access in Availity? Highmark Blue Shield (PA) Highmark Blue Cross Blue Shield (PA) Highmark Blue Cross Blue Shield (DE) Highmark Blue Cross Blue Shield (WV)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.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. …If necessary, the designated fax number for medical injectable authorization requests (including Site of Care drug authorization requests) is 833-581-1861. The Site of Care request fax form can be found here on the Provider Resource Center in the left-hand menu under FORMS then Medical Injectable Drugs. Last updated on 10/26/2023 2:15:18 PM.Follow this link to access the CAQH. ( Previously referred to as the Universal Provider Datasource.) Under Provider Sign In, enter your username and password if registered, or select register now. Enter your CAQH Provider ID. (If you don't know it, call CAQH at 1-888-599-1771). Enter or update your information.New Fax Number: (833) 559-2857. Access the new fax cover page here. Providers will no longer be able to submit authorization requests by email after 4/30/24, as the [email protected] email address will be disabled. In addition, the Adagio fax number (412) 201-4701 will no longer be active after 4/30/24.A newsletter for Highmark Blue Cross Blue Shield providers in western Pennsylvania. Issue 2, February 2024. IN THIS ISSUE: General News; ... HOME ABOUT THIS NEWSLETTER CONTACT US LEGAL INFORMATION ARCHIVE AVAILITY PROVIDER RESOURCE CENTER. Directory Information - Here's How to Attest.5/21/2024. Ensuring Quality Care and Service through our QI/UM Program. 5/21/2024. Jimmo Settlement Coverage and Training Policies. 5/21/2024. Clinical Practice and Preventive Health Guidelines. 5/21/2024. Mark Your Calendar for the 2024 Provider Compliance Assessment Training. 5/21/2024.Annual Update to Highmark's Professional Fee Schedule & Pricing Methodology. 5/14/2024.Call-center agents will ask series of questions to determine compliance with Highmark Wholecare Accessibility Standards.\u003cbr /\u003e The call-center agent will request that the office appointment schedule be reviewed (real-time) to obtain a specific date and time of the office\u0026rsquo;s next available appointment.\u003cbr /\u003e ...Please use 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.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.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.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.Each reimbursement policy includes information pertaining to all Highmark markets as indicated in the header, with state specific variations indicated within the policy bulletin. History versions of reimbursement policies are stored within the PDF files. Click the "View History" link on the first page of the policy to view previous versions.Complete ALL information on the form. NOTE: The prescribing physician (PCP or Specialist) should, in most cases, complete the form. Please provide the physician address as it is required for physician notification. Fax the COMPLETED form and all clinical documentation to 1-866-240-8123. Or mail the completed form to:The Centers for Medicare and Medicaid Services (CMS) requires of Highmark and its network providers that current, accurate provider data is published in Highmark's Provider Directory. The Provider Directory is an important tool that helps our members contact practitioners, and the data itself is what drives timely and accurate claims processing.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.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 Manage My Organization to List All Billing Groups in Your Practice/Facility. Highmark contracts with providers at the group level, so when adding "Providers" in Manage ...Thank you for taking the time to provide this important service to your patients, our members. If you have any questions regarding this request, please contact your Provider Relations representative, or you may contact Provider Data Services at 1-866-763-3224. Camp Hill, PA 17089.Prosthetics and Orthotics Procedure Codes to be Adjusted in DE, PA, and WV.PROVIDER RESOURCE CENTER . Highmark's Provider Resource Center is dedicated to providers and contains lots of helpful information and resources to assist you in your daily interactions with Highmark and with Highmark members. The Provider Resource Center is designed to provide easy access to information and documents.RP-026 Portable Radiography and ECG Services. A “Related Highmark Policies” section was added. RP-041 Services Not Separately Reimbursed. Codes 38204, 90889, 92605, 92606, 92618, 93740, and R0076 were added for Commercial products. These codes will be considered not separately reimbursed and rejected as non-billable to the member.This program supports Highmark Wholecare’s mission to improve the health and wellness of the individuals and the communities we serve by providing access to integrated, superior health care. 2024 Program Overview. Providers must opt-in to the program (either/both the Highmark Wholecare Practitioner Excellence (HWPE) Program …Annual Update to Highmark's Professional Fee Schedule & Pricing Methodology. 5/14/2024.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.