Learn More. The Peer-to-Peer request must be received by Maryland Amerigroup maryland prior authorization Care within two 2 business days of the initial notification of the denial. The intent of the Peer-to-Peer is to discuss the denial decision with the ordering clinician or attending physician. For specific details prioe authorization requirements, please refer to our Quick Reference Guide. Certain carefirst mental providers require prior authorization regardless of place of service.
Wellmark Blue Cross and Blue Shield. Blue Cross and Blue Shield of Kansas. Blue Cross and Blue Shield of Louisiana. Blue Cross and Blue Shield of Massachusetts. Blue Cross Blue Shield of Michigan. Blue Cross and Blue Shield of Minnesota. Blue Cross and Blue Shield of Montana. Blue Cross and Blue Shield of Nebraska. Blue Cross and Blue Shield of Oklahoma.
Regence BlueCross BlueShield. BlueCross BlueShield of Tennessee. Blue Cross and Blue Shield of Texas. Blue Cross and Blue Shield of Vermont. Blue Cross Blue Shield of Wyoming. Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.
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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. Professional Initial Credentialing Set Up. The online solution will guide you through the process, which will take several hours to complete the first time however, the application does not need to be completed all at one time. Helpful resources are available through links on the login page to help you initially navigate the system. 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. 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. 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. Quick Links: Manuals. Highmark Provider Manual.
Call Provider Services at , Monday–Friday, 8 a.m.–5 p.m., with any questions or concerns. Provider Services is here for you and is your first point of contact for Highmark . Highmark Health continually builds on its strong tradition of community support established more than years ago by our affiliate companies. We believe that we have a fundamental responsibility to be leaders and stewards in the community. Our corporate headquarters in Pittsburgh, is a proud reflection of our commitment to the community. Call TTY: (Monday - Sunday am to pm EST) to talk to a representative who can answer questions about our plans. Mailing Address Highmark Blue Cross Blue Shield P.O. Box Pittsburgh, PA Please include your group and ID .