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First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield.Your session is about to expire! Click the button below to extend your session and stay logged in. You will be logged out after 5 more minutes of inactivity.Provider data changes can be made by visiting the provider portal or by using the Provider Information Management Forms section of the Provider Resource Center. After you submit your form successfully, Highmark will retain an electronic copy of your CAQH ProView profile in its database and will send you a confirmation email.The full fee schedule is available on the Provider Resource Center. Access by signing into Availity > Payer Spaces > Highmark > Provider Resource Center. March 16, 2024. CLOSED. Secure Messaging. Attachment size currently allows for a total 45MB for 1 – 10 attachments.Highmark continually seeks ways to make its network credentialing process easier for our providers. Find the information and forms you'll need to get your organization credentialed. Organizational Credentialing Authentication RequiredFirst Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield.Behavioral Health Fax Number for Authorization Requests: 1-877-650-6112. For precertification or continued stay review requests for Behavioral Health treatment, please submit relevant clinical information via fax to 1-877-650-6112. Submission of the complete medical record may slow down the process and is not an efficient way to communicate the ...First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield.Organizational Credentialing Forms. Recredentialing Application for Facility and Ancillary Providers. If you have recently received a letter stating that you must recredential, please use this form to enter the requested information. Change of Ownership (CHOW) Form. Please use this form to report any changes in ownership which may include the ...Published March 28, 2022. Following is the update to the Highmark Drug Formularies and pharmaceutical management procedures for January 2022. The formularies and pharmaceutical management procedures are updated on a bi-monthly basis, and the following changes reflect the decisions made in January 2022 by our Pharmacy and Therapeutics Committee.Following is the update to the Highmark Drug Formularies and pharmaceutical management procedures for December 2022. The formularies and pharmaceutical management procedures are updated on a bi-monthly basis, and the following changes reflect the decisions made in December by our Pharmacy and Therapeutics Committee.Putting patients first means giving members access to high-quality care. It's about convenience and quality. That's why we constantly work to identify high-performing providers and offer access to alternative care locations such as clinics, local facilities, and in-home care. To that end, Highmark has measured a specific set of performance ...Home Health/Home Infusion Therapy/Hospice: 888-567-5703. Inpatient Clinical: 800-416-9195. Medical Injectable Drugs: 833-581-1861. Musculoskeletal (eviCore): 800-540-2406. Telephone: For inquiries that cannot be handled via the online provider portal, call the appropriate Clinical Services number, which can be found here.The 2024 Preventive Health Guidelines are now available on the Provider Resource Center. Every year, Highmark and participating network physicians review and update the Preventive Health Guidelines, which are made available to the practitioner community as a reference tool to encourage and assist you in planning your patients’ care.Highmark has Answers. Get answers to questions about health insurance coverage. Learn more about health plans and insurance terms and definitions. Highmark Inc. is a health and wellness organization located in Pittsburgh and operates health insurance plans in PA, DE, WV, Northeastern NY and Western NY.Provider data changes can be made by visiting the provider portal or by using the Provider Information Management Forms section of the Provider Resource Center. After you submit your form successfully, Highmark will retain an electronic copy of your CAQH ProView profile in its database and will send you a confirmation email.NOTE: 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 the completed form and all clinical documentation to 1-866-240-8123 Or mail the form to: Clinical Services, 120 Fifth Avenue, MC PAPHM-043B, Pittsburgh, PA 15222.Change of Ownership (CHOW) Form - This form is for Facility and Ancillary Providers to report any changes in ownership, which may include the Legal Name, Doing Business As name, NPI, or Tax ID information.. 24/7 Coverage Form - 24/7 coverage is a requirement for participation in the Highmark Credentialed networks.Please complete this form to indicate how 24/7 coverage is provided by your ...

The full fee schedule is available on the Provider Resource Center. Access by signing into Availity > Payer Spaces > Highmark > Provider Resource Center. Attachment size currently allows for a total 45MB for 1 - 10 attachments. Allow for attachment total size of 100MB for 1 - 10 attachments.Standard Rates for medical specialty drugs and injections are reimbursed at the Average Sale Price ("ASP") minus 6%. For more information, call Provider Services at 1-844-325-6251, Monday-Friday, 8 a.m.-5 p.m. Provider resources for Highmark Health Options include: external resources, provider manual, provider contracts and procedure codes.Highmark Provider Manual Tip Sheet Index. This page is intended to be a collection of all tip sheets embedded throughout the units of the Highmark Provider Manual. These easy-to-use, printable documents provide relevant information and practical tips for many Highmark procedures. Highmark has incorporated this feature in response to provider needs.Highmark Wholecare providers are invited to use the 2024 Care Gap Management Application (CGMA). This application, live as of April 1st, supports Highmark Wholecare’s mission to improve the health and wellness of the individuals and the communities we serve by offering providers access to important care gap information.Our mailing address is: Highmark Fifth Avenue Place 120 Fifth Avenue Pittsburgh, PA 15222-3099 (412) 544-7000 (TTY/TDD: 711)

Annual Update to Highmark's Professional Fee Schedule & Pricing Methodology. 5/14/2024.MEDICAID REDETERMINATION. ACA/CHIP Provider Flyer for Medicaid Redetermination. Last updated on 2/7/2024 2:21:17 PM.…

Reader Q&A - also see RECOMMENDED ARTICLES & FAQs. Step 1: Highmark Training. Step 2: Medicare Parts C and. Possible cause: The Centers for Medicare and Medicaid Services (CMS) requires of Highmark and its netw.