On this page, you will find various forms that providers may use when communicating with Highmark Delaware, Highmark Delaware members or other providers in the network. Affirmation of Medical Practice Statement. Bone Density Information Form. Discharge Notification Form. General Certificate of Medical Necessity.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.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 …Apr 16, 2024 · Highmark Blue Cross Blue Shield (WNY) recognizes that there are services you provide to many of our members outside of the typical office visit that you're currently not compensated for. To view information on our Best Practice reimbursement, please access the Provider Resource Center through the provider portal. Once you've reached the private ...Prior Authorization of Sedative Hypnotics- Pharmacy Services. 11/9/2023. 33-23-43. Prior Authorization of Migraine Prevention Agents. 11/9/2023. 33-23-50. Prior Authorization of Tubeless Insulin Delivery Devices - Pharmacy Services. 11/9/2023. 33-23-47.Quick Claims Functionality in Availity Now Available for Highmark Providers. 4/17/2024.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. Authorize Highmark BCBSWNY to access your information electronically.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.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.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.If you are a Highmark member, please review and discuss any questions regarding pharmacy policies with your treating provider and refer to your specific benefit plan for the terms, conditions, limitations and exclusions of your coverage. The benefit plan will define which supplies and services are covered, excluded and/or subject to limitations ...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:Find out how to join the Highmark network, get prior authorization, review medical policies, and access pharmacy information. Use Availity to validate eligibility and benefits, check claim status, and more.Highmark's Kidney Health Management (KHM) program (Powered by Healthmap) uses advanced analytics to identify and support patients diagnosed with chronic kidney disease (CKD) or end stage renal disease (ESRD) that may benefit from additional care intervention. To learn more about the program, you can read our provider handout or view the video ...Our mailing address is: Highmark Fifth Avenue Place 120 Fifth Avenue Pittsburgh, PA 15222-3099 (412) 544-7000 (TTY/TDD: 711)Provider Information Management forms are used to maintain provider accounts as well as begin the process to join Highmark's networks for new practitioners and offices. Practice information updates can be made with many of the forms below. Please carefully read and follow the instructions contained within the individual form for submission.For providers with Highmark BCBSWNY members who remain on the BCBSWNY Legacy System ... "Read","description":"\u003cp\u003e\u003cem\u003eBecause the Highmark Blue Cross Blue Shield of Western New York Provider Resource Center site was not yet live on August 30th when this Medical Policy Update was distributed, we\u0027ve …Highmark Wholecare covers family planning services. These services include: Pregnancy testing. Testing and treatment of sexually transmitted diseases. Birth control supplies, including up to a 12-month supply of oral contraceptives. Family planning education and counseling. In April 2014, the Office of Population Affairs (OPA) and the Centers ...Call the Provider Service Center for your region. Enter the provider's NPI number. Enter the member's Highmark ID or social security number. Enter or say the member's birthdate. Say "Authorization.". Say "Check Status" press "1.". Enter authorization reference number (skipping any letters or symbols).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 ...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.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.NOCD provides Highmark members with live one-on-one video therapy with exposure and response prevention (ERP)-trained therapists, access to a peer community, and a personalized self-management tool. Available to Commercial and ACA members in Delaware, New York, Pennsylvania, and West Virginia (age 5 or older). Alcohol use disorder.Nigerian internet and data services provider MainOne will be sold to US-based Equinix for $320 million. Equinix, a California-based provider of internet and data center services, a...Highmark's Provider Resource Center (PRC) - the main hub for important information, including policies, procedures, the Highmark Provider Manual, and Provider News. Interactive Voice Response (IVR) System - The Provider Service Center offers options for you to access information, such as claim status or member benefits, without a live agent.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.Call the Provider Service Center for your region. Enter the provider’s NPI number. Enter the member’s Highmark ID or Social Security number. Enter or say the member’s birthdate. Say “Authorization.”. Say “Check Status” press “1.”. Enter authorization reference number (skipping any letters or symbols). IVR Tip – Have Your ...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.First,usersshouldclick on their initials in the upperrightcornerand selectthe Log offoption. Second,closebothtabs to returnto NaviNet. When starting a new authorization,theAcknowledgement screenshould bedisplayed. The screen below will be displayed when an authorization is auto-approved. NaviNet® Provider Portal Authorization Inquiry.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 …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 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.The Highmark Blue Shield Regulations for Participating Providers, PremierBlue Shield Providers and Government Sponsored Program Providers were updated. The Highmark Professional Provider Agreement Regulations were added with an effective date of January 1, 2024. November 17, 2023. Chapter 2, Unit 1: Product OverviewTool 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.Highmark has incorporated MCG Health evidence-based clinical guidelines into our criteria of clinical decision support, replacing Change Healthcare ... Imaging: These are presently managed by eviCore which uses their own medical policy (policies are available on Highmark's Provider Resource Center).On this page, you will find some recommended forms that providers may use when communicating with Highmark, its members or other providers in the network. Assignment of Major Medical Claim Form. Authorization for Behavioral Health Providers to Release Medical Information. Discharge Notification Form. Expanded Provider Directory …The 2024 Preventive Health Guidelines are now available on the Provider Resource Center. Every year, Highmark and participating network physicians review and update the Preventive Health Guidelines, which are made available to the practitioner community as a reference tool to encourage and assist you in planning your patients' care.To help providers transition to a post-PHE environment, they were given 90 days to prepare for Highmark’s policy changes and insurance plans/product updates that took effect on July 6, 2023. To see the full list of changes and updates, read our Special Bulletin (updated June 28, 2023).Back to Behavioral Health Toolkit. Resources: CDC What is Autism Spectrum Disorder? CDC Learn the Signs. Act Early. National Institute of Neurological Disorders and Stroke Autism Spectrum Disorder. Autism Care Network (ACNet), Provider site: Better Autism Care - Autism Care Network. Autism Intervention Research Network on Physical Health (Air ...If the issue persists, contact [email protected]. Segment 2: Initiative Sharing with Mt. Nittany Medical Center. Panelists: Moderator: Phil Majewski MD, MPH; Medical Director, Population Health, Highmark Health. Gandhi SO, Sabik L. Emergency department visit classification using the NYU algorithm.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 …These resources are for Federally Qualified Health Centers and Rural Health Clinics. They include provider in-service materials, billing information, roster template and instructions, provider portal references, DHS & CMS regulatory requirements and more. Annual Provider Education. Highmark Wholecare Organizational Provider Participation ...Highmark’s Provider Resource Center (PRC): You are here! The PRC is the main hub for you and your staff to review important information and tools, such as EFT registration, policies, procedures, and the Provider Manual. Availity Essentials, Highmark’s Provider Portal: The primary method to submit transactions to Highmark and access reports: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 …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 ...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 ...Information Center. The BlueCard Program allows participating Blue Plan providers in every state to submit claims to their local Blue Plan for indemnity, PPO and managed care patients who are enrolled in an out-of-area Blue Plan. Provided below are selections with information that can assist your office with questions you may have about …Highmark’s Provider Resource Center (PRC): You are here! The PRC is the main hub for you and your staff to review important information and tools, such as EFT registration, policies, procedures, and the Provider Manual. Availity Essentials, Highmark’s Provider Portal: The primary method to submit transactions to Highmark and access reports:Prosthetics and Orthotics Procedure Codes to be Adjusted in DE, PA, and WV.Quick Claims Functionality in Availity Now Available for Highmark Providers. 4/17/2024.chevron_left training-and-resources print PRINT Print share SHARE Share with social media. Share ... Provider Service Center. Can't find an answer? Call us: 8 a.m. to 5 p.m. EST, Monday through Friday. ... All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or ...Our mailing address is: Highmark Fifth Avenue Place 120 Fifth Avenue Pittsburgh, PA 15222-3099 (412) 544-7000 (TTY/TDD: 711)For our provider partners, True Performance reduces the complexity of multiple programs, offers a higher performance based reimbursement opportunity, and provides timely and actionable reporting. PCP entities with 250 or more members will be eligible to participate in the new program. Log in to NaviNet, then navigate to the Resource Center for ...Advanced Imaging and Cardiology Services Program. Behavioral Health Resources. Behavioral Health Telemedicine and Virtual Visits. Laboratory Management Program. Musculoskeletal Surgery and Interventional Pain Management Services Prior Auth Program. Physical Medicine Management. Post-Acute Care Management for Medicare Advantage Members.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.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 Medicine ...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 …Highmark Blue Shield Provider Resource Center (Central, Eastern and Northeastern PA) ... CGI Call Center for Highmark Phone number: (877) 817-5954 Mon-Fri 8:00 a.m. to 5:00 p.m. EST E-mail Address: [email protected] Fax - Medical Records: (216) 687-4249 Fax - Appeals / Additional Info: (216) 685-9418.Go to the PROVIDER TOOLS AND RESOURCES section further down on this page. Adult Preventive Screening Reminders. These reminder cards can be disseminated to your patients while at the office or mailed to their home. Breast Cancer Screening Reminder Card. Cervical Cancer Screening Reminder Card. Colorectal Cancer Screening Reminder Card.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.To help providers transition to a post-PHE environment, they were given 90 days to prepare for Highmark's policy changes and insurance plans/product updates that took effect on July 6, 2023. To see the full list of changes and updates, read our Special Bulletin (updated June 28, 2023).If you must submit a telephonic request, call the appropriate phone number below to reach Medical Management & Policy: Western Region: 1-800-547-3627. Central, Eastern and Northeastern Regions: 1-866-731-8080. For Medicare Advantage Members, call: FreedomBlue PPO: 1-866-588-6967. Medicare Advantage HMO: 1-866-517-8585.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 …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.Highmark Wholecare is aware of a cyber security incident impacting Change Healthcare - an outside vendor that supports health care providers and vendors with electronic submissions to payers such as the filling of prescriptions and health care claims. This is a widespread disruption affecting health care providers and some pharmacies nationwide.Provider Resource Center. In December 2016, the 21st Century Cures Act was enacted into law by the 114th United States Congress. Section 212006 of the Cures Act requires all states to implement the use of Electronic Visit Verification (EVV) for Medicaid-funded personal care and home health services that require an in-home and community …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.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.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.This publication focuses only on medical policy and claims administration updates, including coding guidelines and procedure code revisions, and is the sole source for this ...July 11, 2024. 12:00 – 1:00 p.m. Highmark Wholecare's Financial Investigations and Provider Review (FIPR) Division will be hosting a live provider …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 …Organizational Credentialing Forms. Recredentialing Application for Facility and Ancillary Providers. If you have recently received a letter stating that you must recredential, please use this form to enter the requested information. Change of Ownership (CHOW) Form. Please use this form to report any changes in ownership which may include the ...Back to Behavioral Health Toolkit. Resources: CDC What is Autism Spectrum Disorder? CDC Learn the Signs. Act Early. National Institute of Neurological Disorders and Stroke Autism Spectrum Disorder. Autism Care Network (ACNet), Provider site: Better Autism Care - Autism Care Network. Autism Intervention Research Network on Physical Health (Air ...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.Find the latest updates and information for Highmark providers, including special bulletins, contract upload form, and quick claims functionality. Learn about Highmark's programs and initiatives for immunization, respiratory panels, channel alignment, and more.NaviNet. NaviNet's Quick Start Guide — available on the Provider Resource Center — has step-by-step procedures for conducting both claim status inquiries and claim investigations. The guide features easy-to-follow instructions accompanied by screenshots showing users what to do during each step. The Claim Status Inquiry function allows you to view real-time, detailed claim information ...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.Attached please find 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.Issue 2. Provider Resource Center Provides Answers at Your Fingertips. Issue 1. Reporting Requirements for Facility Mergers, Acquisitions and Changes. Issue 1. Successful Discharge Planning in Skilled Nursing Facilities. Issue 1. Highmark Skilled Nursing Facility Pay for Value Program. Issue 1.Consent isn’t all that complicated. And yet according to a study from the National Sexual Violence Resource Center, there’s still lots of confusion over what “counts” as sexual ass...Nursing Facility Service codes (99304-99310, 99315, 99316) Home or Residence Service codes (99341, 99342, 99344, 99345, 99347-99350) Except for Emergency Department codes (99281-99285), providers may choose the appropriate E/M level of care based on either Time or Medical Decision Making (MDM). Emergency Department codes (99281-99285) use only ...Nursing Facility Service codes (99304-99310, 99315, 99316) Home or Residence Service codes (99341, 99342, 99344, 99345, 99347-99350) Except for Emergency Department codes (99281-99285), providers may choose the appropriate E/M level of care based on either Time or Medical Decision Making (MDM). Emergency Department codes (99281-99285) use only ...The Provider File Management (PFM) tool allows professional providers to view and make changes to their practice information. Changes to your practice information will be updated in real -time. Since Highmark uses this information for member directories and claims processing, it is vitally important that Highmark has the most up-to-date and ...