Providers.highmark.com

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WebHighmark's Provider Resource Center is your source for all provider-related information and updates. The PRC offers resources to assist in the treatment of your Highmark patients, …

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URL: https://providers.highmark.com/

Medical Policies

WebFind comprehensive medical policy guidelines for all of Highmark’s medical-surgical products, including managed care.

Category: Medical Go Health

Claims and Authorization

WebClaims & Authorization Understand Highmark's authorization requirements, get guidance on reimbursement policies and programs, and find helpful resources and tips.

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Behavioral Health Resources

WebHighmark strives to actively help providers identify members who can benefit from fully accessing their mental health/substance use disorder benefits in a timely manner. Get …

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Medical Policy FAQs

WebMedical Policy is the department responsible for the development and maintenance of all medical policies for our medical-surgical contracts. Medical Policy is comprised of …

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Pharmacy Prior Authorization Forms

WebForms Authorization Forms Pharmacy Prior Authorization Forms Behavioral Health Forms

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Enhanced Community Care

WebEnhanced Community Care Management (ECCM) is a non-billable service offered for members of certain Highmark plans. ECCM is designed to support the most complex and …

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Medicare Formulary

Web100-Day Supply Tip Sheet. Beginning in 2024, Highmark’s Medicare Part D plans will cover a 100-day supply of generic medications on Tier 1 and Tier 2 of the Medicare formularies.

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WEIGHT LOSS MEDICATIONS FORM Fax to 1-866-240-8123

WebNOTE: 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 …

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Obtaining Authorizations

WebThe preferred – and fastest – method to submit preauthorization requests and receive approvals is the online provider portal. The online provider portal (Availity) is designed to …

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Free Market Health

WebUpon an approved prior authorization for select specialty drugs, Free Market Health receives the patient referral for management. Note: if the authorization request is …

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Authorization Guidance

WebBefore you submit for prior authorization on Availity, we recommend that you consult Member Eligibility & Benefits. If you don’t have access to Availity, you can review other …

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Authorization Forms

WebPharmacy Prior Authorization Forms. Find additional information and updates in Provider News: Provider News. Availity’s multi-payer platform will support the existing payer …

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Highmark Provider Service Center Quick Reference Contact …

WebWestern Region: Professional Providers 800-547-3627; Facilities 800-242-0514. Hours of Availability: 8 a.m. to 5 p.m. EST, Monday through Friday. Central & Northeastern …

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MCG Clinical Criteria

WebRadiology and Cardiology Imaging: These are presently managed by eviCore which uses their own medical policy (policies are available on Highmark’s Provider Resource …

Category: Medical Go Health