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Some content may be reserved for participating physicians, health care professionals and facilities. To view this reserved content, you must access our information through NaviNet. Please note that these forms are to be used by Federal Employee Program Members only. Policy Update: Antibody Testing Claims. Coverage for antibody infusion therapy. Update: Antibody Testing Claims. Our Commitment. Join Our Networks.

Our Healthcare Facilities. AIM Specialty Health. BlueCard Program. Braven Health. Braven Health Supportive Care Program. Case Management. Chronic Care Program. Horizon Behavioral Health.

Horizon Care Home. Horizon Supportive Care Program. Medical Injectables Program. Our Pledge. Patient Health Support. Pharmacy Programs. Recognition Programs and Partnerships.

Risk Adjustment Overview. Self Service. Surgical and Implantable Device Management Program. We encourage you to review this catalog to help you identify members who can benefit from the programs and services we offer.

This feature is available to providers who use NaviNet. If you have not yet signed up for NaviNet, visit www. This feature will help to: Ensure that patients with chronic conditions and complex medical needs are connected with the right clinical support for their needs.

Simplify and expedite the overall case management referral process.

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Highmark blue cross navinet Simplify and expedite source overall case management referral process. Join Our Networks. Educational Webinars. Horizon Care Home. Our Pledge. Value-Based Programs.
Accenture talent portal To view this reserved content, you must access our information through NaviNet. Join Our Networks. Clinical Practice Guidelines. Follow the steps to create and submit the referral. Feature Stories.
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Nursing jobs kaiser permanente Utilization Management. Risk Adjustment Overview. Medical Injectables Program. Surgical and Implantable Device Management Program. Chronic Care Program. Cultural Competency.

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Benefit plans vary widely and are subject to change based on the contract effective dates. The provider is responsible for verification of member eligibility and covered benefits. Effective dates are subject to change. Highmark will provide written notice when codes are added to the list; deletions are announced via online publication.

Examples of services that may require authorization include the following. This is not an all-inclusive list. Benefits can vary; always confirm member coverage. The online portal is designed to facilitate the processing of authorization requests in a timely, efficient manner. If you are a Highmark network provider and have not signed up for NaviNet, learn how to do so here. Highmark recently launched a utilization management tool, Predictal, that allows offices to submit, update, and inquire on medical inpatient authorization requests.

Fax: If you are unable to use NaviNet, you may also fax your authorization requests to one of the following departments. The associated preauthorization forms can be found here. Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number , which can be found here. Highmark contracts with WholeHealth Networks, Inc.

Additional information about the programs and links to prior authorization codes are available under Care Management Programs in the left website menu.

Authorization number not appearing, unable to locate member, questions about clinical criteria screen. Contact Us. Provider Directory. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania.

Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania.