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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.

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Highmark bcbs provider contact

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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. Medical Policy Medical Policy. Medical Policies. Medicare Advantage Medical Policies. Responsible for reviewing and processing additions, updates, and deletions of provider information in the Provider File database.

Ensures executions of data entry and updates are completed in a timely and accurate manner. Maintain accurate data in provider file data systems. Common transactions include:. Data Integrity. Contact external sources to collect or clarify information or documentation which in turn must be reviewed and evaluated against the established guidelines and procedures to ensure the file meets all policy and procedures in conjunction with regulations. Maintain and update internally required data elements which include but are not limited to:.

Please Note : There will be a training class for 6 -7 weeks from am - pm. The Work shift will be from am - pm. There is a two - hour flex window where the candidate start time can be between am am with a 8 hour working shift. Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title.

It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.

This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

We endeavor to make this site accessible to any and all users.

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Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.

This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. We endeavor to make this site accessible to any and all users.

If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below. This website uses cookies. It uses cookies to ensure that it gives you the best experience on our website. If you continue without agreeing to the cookie conditions, we'll assume that you are happy to receive all cookies on this website.

Read more. Covid Vaccination Information Effective November 1, , Highmark Health and its affiliates are requiring all new hires beginning employment to submit proof of full vaccination with one of the three authorized COVID vaccines. File Maintenance Analysis.

Routinely contact external sources such as the Provider offices, state licensing agencies and provider reps to collect or clarify information or documentation, which in turn must be reviewed and evaluated against the established guidelines Ensure the file meets all regulations prior to updating the provider file 3.

Maintain and update internally required data elements which include but are not limited to: Assigned Blue Shield provider numbers National Provider Identifier NPI CMS required provider identifiers for compliance with corporate and federal contracts. This individual will be also responsible to educate providers for obtaining and updating provider identifiers. Providers who participate with Highmark and are interested in more information on NaviNet can visit the NaviNet Web site at www.

To speak to a NaviNet Customer Care Representative directly, please call during the hours listed above at Online contacts Provider Relations - provrel highmarkbcbsde. Highmark Delaware Holiday Schedule.

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. Health Options Provider Manual. Medical Policy Medical Policy. Medical Policies.

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WebLocal () Monday - Friday: a.m. - p.m. Saturday & Sunday: Closed Corporate Street Address: Highmark Blue Cross Blue Shield of Western New York West Genesee Street Buffalo, NY Are you a member? Have a question or comment? Mailing Address: Highmark Blue Cross Blue Shield of Western New York . WebJan 13, †∑ Highmark Blue Shield announced that Dan Tropeano has been named the organizationís first ever Southeastern Pennsylvania segment president, a major milestone as Highmark plans to strengthen its statewide presence and community-focused service by offering a wide range of health insurance solutions in Southeastern Pennsylvania starting . WebMar 1, †∑ Contact Us Provider Directory Site Map Legal Information 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 .