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.
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. Be sure to select Highmark as a plan authorized to receive your information.
Please access the initial credentialing request form and complete the form by providing your information in the blue [required] fields. Highmark continually seeks ways to make its network credentialing process easier for our providers.
We are required by federal law and the American Accreditation HealthCare Commission to initially credential providers who participate in Highmark's preferred provider networks and in Highmark's Medicare Advantage network. These specialties are currently closed to network enrollment. Highmark performs outreach in the provider community when such services are determined to be a need.
While closed network applicants are rarely considered, we do provide an option for special consideration.
This process occurs before credentialing can begin. Interested providers can complete the Special Consideration Questionnaire , which will be reviewed by the Contracting Department. 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.
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