Highmark blue cross blue shield procedure codes

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Kaiser permanente hollywood	Highmark recently launched a utilization management tool, Predictal, that allows offices to submit, update, and inquire on medical inpatient authorization requests. Medicare Advantage Medical Policies. Manuals Highmark Click here Manual. Pharmacy Policy Search. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania.
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David mccue conduent	Contact Us. Disclaimer Highmark Coding Tips articles are intended to reflect Highmark's correct coding guidelines. Coes you are a Highmark network provider and have not signed up for NaviNet, learn how to do so here. Fax: If you are unable to use NaviNet, you may also fax your authorization requests to one of the following departments. Current Dental Terminology. All rights reserved.
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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. 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. These guidelines address medical services, including diagnostic and therapeutic procedures, injectable drugs, and durable medical equipment.

We review our existing medical policies to reflect scientific-based evidence and the current standard-of-care. Procedure codes and diagnosis codes applied to each policy are integrated into the claims processing system which ensures accurate administration of member benefits.

Medical Policy Update Newsletter - Medical Policy Update is a monthly newsletter for the health care providers who participate in our networks and submit claims to Highmark using the appropriate HIPAA transactions or claim forms as required by Highmark.

Highmark is a nationally recognized industry leader in developing and implementing up-to-date, medically sound policy guidelines. There are many policy guidelines addressing medical technology, therapeutic procedures, medical equipment and supplies, and behavioral health. They are used to administer all Highmark medical-surgical products and various fee schedule products. In addition to commercial products, we also maintain medical policy coverage guidelines for our Medicare Advantage products.

Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. They are intended to reflect Highmark's reimbursement and coverage guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract, and subject to the applicable laws of your state. Highmark retains the right to review and update its medical policy guidelines at its sole discretion.

These guidelines are the proprietary information of Highmark. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use. Contact Us. Provider Directory.