Highmark prior authorization

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Some authorization requirements vary by member contract. This information should not be relied on as authorization for health care services and is not a guarantee of payment. Benefit plans vary widely and are subject to change based on the contract effective dates. The provider is responsible for verification of member eligibility and covered benefits. Effective dates are subject to change.

Highmark will provide written notice when codes are added to the list; deletions are announced via online publication. Examples of services that may require authorization include the following.

This is not an all-inclusive list. Benefits can vary; always confirm member coverage. The online portal is designed to facilitate the processing of authorization requests in a timely, efficient manner.

If you are a Highmark network provider and have not signed up for NaviNet, learn how to do so here. Highmark recently launched a utilization management tool, Predictal, that allows offices to submit, update, and inquire on medical inpatient authorization requests. Fax: If you are unable to use NaviNet, you may also fax your authorization requests to one of the following departments. The associated preauthorization forms can be found here. Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number , which can be found here.

Highmark contracts with WholeHealth Networks, Inc. Additional information about the programs and links to prior authorization codes are available under Care Management Programs in the left website menu. Authorization number not appearing, unable to locate member, questions about clinical criteria screen.

Contact Us. Provider Directory. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. As of September 1, the Prior Notification component of Highmark's Radiology Management Program will require all physicians and clinical practitioners to obtain prior notification when ordering stress echocardiography.

This authorization requirement doesn't apply to emergency room or inpatient scans. Please review this material and be prepared to contact NIA Magellan - the imaging management firm that is supporting the program - before ordering the select diagnostic imaging procedures. Effective Oct.

Back to Radiology Management Home Page. 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.