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Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania.
Quick Links: Manuals. Highmark Provider Manual. Medical Policy Medical Policy. Medical Policies. Medicare Advantage Medical Policies. Requiring Authorization. Pharmacy Policy Search. Message Center. Manuals Highmark Provider Manual. Authorization Requirements.
Inpatient admissions e. Inpatient Authorization Guide : Click here for the Predictal step-by-step inpatient authorizations reference guide. Outpatient Authorization Guide : Click here for the Predictal step-by-step outpatient authorizations reference guide.
Questions about authorization workflows. Check status of submitted authorizations. Site Map Legal Information. NaviNet Portal. Authorization Workflows. Authorization Status. ElecAuthSubmit highmark. Some authorization requirements vary by member contract. This information should not be relied on as authorization for health care services and is not a guarantee of payment.
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. To request an authorization for post-acute care services for Medicare Advantage members, you'll need to complete one of the following forms found here.
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.
Dec 14, аи Authorization Requirements Highmark requires authorization of certain services, procedures, and/or Durable Medical Equipment, Prosthetics, Orthotics, & Supplies . Nov 7, аи Authorization Forms Bariatric Surgery Precertification Worksheet Behavioral Health Authorization Form Behavioral Health (Outpatient - ABA) Service Authorization . Oct 24, аи Pharmacy Prior Authorization Forms Addyi Prior Authorization Form Blood Disorders Medication Request Form CGRP Inhibitors Medication Request Form Chronic .