You're being redirected to the CMS search site. Many changes will take effect \u003cstrong\u003eJuly 6, 2023\u003c/strong\u003e. All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. \u003ca href=\"https://content.highmarkprc.com/Files/NewsletterNotices/SpecialBulletins/sb-post-phe-provider-communication.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"\u003e\u003cstrong\u003eCLICK HERE\u003c/strong\u003e \u003c/a\u003efor the details.\u003c/p\u003e","longDescription":null,"visible":false,"archive":false,"liveStatus":2}]. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. When changes are made to the Highmark Provider Manual, we will communicate those changeson our Provider Manual Changes page. For precertification or continued stay review requests for Behavioral Health treatment, please submit relevant clinical information via fax to 1-877-650-6112. This section of the Highmark Provider Manual outlines Behavioral Health provider responsibilities and guidelines. Cng thng tin trng HBK-HQG-HCM. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Here, you can find out how to access the updated fee schedules on the Highmark Provider Resource Center (PRC) and on our legacy provider dashboard. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Welcome to the Highmark Provider Portal. HUTECH reached the top 6 in UniRank 2023 Vietnam University Rankings. All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. Provider Resource Center; Producer Home; Disputes & Appeals; Forms Library; Individuals & Families; Medicare Eligible; Groups & Companies; Federal Employees; . Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Updates include some incremental increases throughout the fee schedule to align with Highmark's fee schedules. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. 2023 CGI Technologies and Solutions Inc. Highmark Blue Shield Provider Resource Center (Central, Eastern and Northeastern PA), Highmark Blue Cross Blue Shield West Virginia, Highmark Blue Cross Blue Shield West Virginia Provider Resource Center (West Virginia and Washington County, OH), Highmark Blue Cross Blue Shield Delaware Provider Resource Center, Provider Web Portal User Guide (downloadable version). Our annual fee schedule update will take effect on October 1, 2022. This manual is designed to be your primary reference guide for working with us. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. The Highmark PRC also features a link to the Blue Bulletin newsfeed on our legacy site. Medical Policy Updateis a monthly newsletter that provides information about upcoming medical policy and claims administration updates. Highmark Choice Company and Highmark Senior Health Company are Medicare Advantage plans with a Medicare contract. Provider Resource Center If you are a newly contracted provider, or a new employee of a network provider's office or facility, we would like to introduce you to the many resources we make available to help you in your interactions with Highmark West Virginia and our members. The link above includes Behavioral Health specific sample treatment records, sample policies, and sample office forms and protocols intended for use to assist in office site evaluations and treatment record documentation compliance. NaviNet gives users real-time access to Highmark's membership, claims and provider and payment systems, making your job easier. There are no decreases. Provider Resource Center The greatest advantage to submitting information electronically is that it saves time and money by alleviating the need for paper forms, envelopes, stamps and by saving the related costs of time and labor. If you wish to begin to submit claims electronically, you may contact the EDI Operations support line at 1-800-992-0246 to speak with a representative. Producer. Once the Professional Provider has attested to and updated their information in CAQH, there is nothing else the provider needs to do. Provider Resource Center Many changes will take effect \u003cstrong\u003eJuly 6, 2023\u003c/strong\u003e. [{"id":39445,"versionId":9502,"title":"Highmark Transitioning From NaviNet to Availity","type":4,"subType":null,"childSubType":"","date":"6/26/2023","endDate":null,"additionalDate":null,"imageUrl":null,"url":null,"urlText":null,"description":"\u003cp\u003e\u003cspan\u003eHighmark is replacing its existing provider portal, NaviNet\u003csup\u003e\u0026reg;\u003c/sup\u003e, with Availity\u003c/span\u003e\u003csup\u003e\u0026reg;\u003c/sup\u003e\u003cspan\u003e\u0026nbsp;Essentials later this year.\u003c/span\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003ca href=\"https://content.highmarkprc.com/Files/NewsletterNotices/SpecialBulletins/sb-availity-transition-announcement-62623.pdf\" target=\"_blank\" rel=\"noopener noreferrer\" title=\"CLICK HERE\"\u003eCLICK HERE\u003c/a\u003e\u003cspan\u003e\u0026nbsp;to read more about the\u0026nbsp;upcoming\u0026nbsp;transition.\u003c/span\u003e\u003c/p\u003e","longDescription":null,"visible":false,"archive":false,"liveStatus":2},{"id":39209,"versionId":9502,"title":"Highmark Post-PHE Changes","type":4,"subType":null,"childSubType":"","date":"4/7/2023","endDate":null,"additionalDate":null,"imageUrl":null,"url":null,"urlText":null,"description":"\u003cp\u003eWith the expiration of the PHE, Highmark has started the process of updating COVID-19-impacted policies and procedures. To access the manual, select MANUALS on the Quicklinks Bar located at the top of the Provider Resource Center. WELCOME TO HIGHMARK! Highmark adheres to the Centers for Medicare and Medicaid Services (CMS) coverage determinations for Medicare Advantage (MA) membership. 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. NaviNet seamlessly integrates all insurer-provider transactions into one system, such as inquiries on referrals/authorizations, eligibility, benefits, claims status, claims investigations, codes, and provider/facility searches. Population Health University - Clinical Pharmacy Resources Available Online. Highmark Provider Manual . \u003ca href=\"https://content.highmarkprc.com/Files/NewsletterNotices/SpecialBulletins/sb-post-phe-provider-communication.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"\u003e\u003cstrong\u003eCLICK HERE\u003c/strong\u003e\u003c/a\u003e for the details.\u003c/p\u003e","longDescription":null,"visible":false,"archive":false,"liveStatus":2}], Member Rights & Responsibilities (Highmark Provider Manual Chapter 1, Unit 5), Entering Service Locations For Specialty Rx Prior Authorization In Navinet, Physician Medicine Mgmt Program - Printable Slide Deck, Virtual Training: Authorization Process Changes for Urgent/Unplanned Inpatient Requests, Medicare Parts C and D General Compliance Training, Combating Medicare Parts C and D Fraud, Waste and Abuse, Billing the Initial Preventive Physical Examination (IPPE) & Annual Wellness Visits (AWVs) for Medicare Advantage Patients FAQs, Value-Based Insurance Design Model Frequently Asked Questions (FAQs), Pharmacy Authorization Submittion Process: Frequently Asked Questions (FAQs), Joint Administration Solutions (JAS) Reference Sheet, Special Needs and Case Management Program, Well-Child Visit/Lead Blood Test/Developmental Screening Requirements & Tips, Filter Paper Lead Blood Testing Information, American Academy of Pediatrics (AAP) Policy Document on Developmental Screenings, Pennsylvania's Telephonic Psychiatric Consultation (TiPs) Program, Tips for Documenting and Coding WCC Visits. Ho Chi Minh City, Vietnam. Below is a timeline of changes made to the Highmark Provider Manual. Submission of the complete medical record may slow down the process and is not an efficient way to communicate the clinical need for an admission or continued stay review. After Step 3, open the link for the Training Attestation. You can get more information by clicking on the Electronic Data Interchange (EDI) Services link in the Claims, Payment & Reimbursementcategory on the left menu. Highmark has your health insurance needs covered. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. Highmark Provider Web Portal You're being redirected to the CMS search site. Step 2: Medicare Parts C and D General Compliance Training. You're being redirected to the CMS search site. For more information on CAQH, please visit their website. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. 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. PHARMACY POLICY - Highmark Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. 6. \u003ca href=\"https://content.highmarkprc.com/Files/NewsletterNotices/SpecialBulletins/sb-post-phe-provider-communication.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"\u003e\u003cstrong\u003eCLICK HERE\u003c/strong\u003e\u003c/a\u003e for the details.\u003c/p\u003e","longDescription":null,"visible":false,"archive":false,"liveStatus":2}], Chapter 3, Unit 2: Professional Provider Credentialing. The provider manual includes information regarding EPSDT requirements such as Blood Lead Screening, Vaccines for Children, Oral Health Risk Assessment, the EPSDT Program, Review of required screens and tests for the EPSDT population. Many changes will take effect \u003cstrong\u003eJuly 6, 2023\u003c/strong\u003e. In this article, you can find more information and view the Provider News webpage on the Highmark Provider Resource Center (PRC). See the \u003ca href=\"https://content.highmarkprc.com/Files/Wholecare/Forms/BetterDoctorProviderFAQ.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"\u003eBetterDoctor FAQs\u003c/a\u003e or the \u003ca href=\"https://questanalytics.com/how-we-help/betterdoctor/\"\u003eBetterDoctor website\u003c/a\u003e for more information.\u003c/p\u003e","longDescription":null,"visible":false,"archive":false,"liveStatus":2}], *Accredited Environmental Technologies (AET) Environmental Lead Investigation Referral Form (*Updated 6/22), Adolescent Drug Alcohol and Tobacco Screening, Pennsylvanias Telephonic Psychiatric Consultation Service Program (TiPS), Age Range Requirements for Screening Visits Desk Guide, Environmental Lead Investigation - Handling of Blood Lead Levels, Bright Futures/ American Academy of Pediatrics Periodicity Schedule, Pennsylvanias EPSDT Program Periodicity Schedule and Coding Matrix, Medical Assistance Bulletin EPSDT Schedule Update September 19, 2022, Medical Assistance Bulletin: Updates to Blood Lead Reference Value and Environmental Lead Investigation (ELI) Provider Qualifications Requirements, Updated June 6, 2022, Pinnacle Childhood Lead Poisoning Prevention and Education Program Referral Form, Psychosocial and Social-emotional Screening Tools, Resource Guide: Care Management of a Child with Elevated Blood Lead Levels, Structured Screening for Developmental Delays and Autism, Validated Screening Tools for Developmental Delays and Autism, Education regarding compliance with recommended testing, such as blood lead level testing, Scheduling assistance for EPDST screenings. Highmark strives to actively help providers identify members who can benefit from fully accessing their mental health/substance use disorder benefits in a timely manner. To Top. The Highmark Provider Manual contains information, policies, and procedures for participating medical providers. Top HR Services in Vietnam - 2023 Reviews | Clutch.co You can also find participation information in Chapter 3 of theHighmark Provider Manual. This form has been created for in-network provider use in order to comply with the No Surprises Act that was signed into law in December 2020. Provider Orientation Page. You can search the entire PRC by entering a keyword in the search bar at the top of the page. Provider Resource Center EST. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Provider Resource Center Highmark Blue Cross Blue Shield of Western New York issues new or updated reimbursement policies regularly. Step 4: Training Attestation. To support this, we will transition our monthly provider communication from Blue Bulletin to Provider News. Beginning in January, youll receive Highmarks monthly Provider News emails at the end of each month replacing Blue Bulletin. If you are a newly contracted provider, or a new employee of a network provider's office or facility, we would like to introduce you to the many resources we make available to help you in your interactions with Highmark and our members. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Here, you can find resources, such as benefit information, reimbursement policy and preauthorization requirements to assist in the treatment of your Highmark Blue Cross Blue Shield of Western New York patients. NaviNet-enabled providers are expected to use this tool for all routine eligibility, benefits and claim status inquiries. The following links are for information regarding Early and Periodic Screening, Diagnostic and Treatment. You can check the Reimbursement Policy page for policy updates and check the PRC homepage for eBulletins announcing new policies. Birth control supplies, including up to a 12-month supply of oral contraceptives. Use this form to update your profile for Medication Assisted Treatment services in Highmark's networks. The Reimbursement Policy page has a search bar specific to reimbursement policies, so you can filter the search results by facility or practitioner. For TDD/TTY services, please call 1-800-480-1419. Highmark - Wikipedia Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. The Highmark Drug Formulary is a list of FDA-approved prescription drug medications reviewed by our Pharmacy and Therapeutics (P&T) Committee. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. An Opioid Treatment Certificate is required to receive payment when providing services at Opioid Treatment Programs (OTPs) to deliver Opioid Use Disorder (OUD) treatment services. Pay Bills. Included are best practice recommendations, screening tools, and clinical practice guidelines. Providers should utilize this electronic form to update a practitioner or group name, address, phone number, email, website address, and specialty or to terminate a practitioner from a group. Provider Resources: EPSDT. [{"id":39447,"versionId":6468,"title":"Highmark Transitioning From NaviNet to Availity","type":4,"subType":null,"childSubType":"","date":"6/26/2023","endDate":null,"additionalDate":null,"imageUrl":null,"url":null,"urlText":null,"description":"\u003cp\u003e\u003cspan\u003eHighmark is replacing its existing provider portal, NaviNet\u003csup\u003e\u0026reg;\u003c/sup\u003e, with Availity\u003c/span\u003e\u003csup\u003e\u0026reg;\u003c/sup\u003e\u003cspan\u003e\u0026nbsp;Essentials later this year.\u003c/span\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003ca href=\"https://content.highmarkprc.com/Files/NewsletterNotices/SpecialBulletins/sb-availity-transition-announcement-62623.pdf\" target=\"_blank\" rel=\"noopener noreferrer\" title=\"CLICK HERE\"\u003eCLICK HERE\u003c/a\u003e\u003cspan\u003e\u0026nbsp;to read more about the upcoming\u0026nbsp;transition.\u003c/span\u003e\u003c/p\u003e","longDescription":null,"visible":false,"archive":false,"liveStatus":2},{"id":39210,"versionId":6468,"title":"Highmark Post-PHE Changes","type":4,"subType":null,"childSubType":"","date":"4/7/2023","endDate":null,"additionalDate":null,"imageUrl":null,"url":null,"urlText":null,"description":"\u003cp\u003eWith the expiration of the PHE, Highmark has started the process of updating COVID-19-impacted policies and procedures. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. The Highmark Provider Manual is your primary reference guide to Highmark. Family planning education and counseling. Provider Resource Center NaviNet can also be used to submit authorization requests, recredentialing applications, and provider information changes. PENNSYLVANIA: Western Region: Professional Providers 800-547-3627; Facilities 800-242-0514 5) How do I contact NaviNet with technical issues? ITPC - Cng thng tin in t Thng mi v u t - About ITPC And finally, please be sure to report any changes to us regarding your office, facility, or participating care providers! \u003ca href=\"https://content.highmarkprc.com/Files/NewsletterNotices/SpecialBulletins/sb-post-phe-provider-communication.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"\u003e\u003cstrong\u003eCLICK HERE\u003c/strong\u003e\u003c/a\u003e for the details.\u003c/p\u003e","longDescription":null,"visible":false,"archive":false,"liveStatus":2}]. NaviNet is a free, Internet-based application for providers to streamline data exchanges between their offices and Highmark. You're being redirected to the CMS search site. We want to make you aware of some of the many provider tools found on the PRC: Our scheduled webinars take place every Wednesday at either 8 am or 12 pm. The following language was added: "After a total of no more than two (2) missed prenatal or one post-partum visit by the member, providers can call for Case Management assistance to request active member outreach at877-878-8785Monday through Friday 8 a.m. to 5 p.m. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Please reference the: HIGHMARK PROVIDER MANUAL: Chapter 3, Unit 2: Professional Provider Credentialingfor additional information related to the credentialing process and requirements. 1. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. The Highmark PRC is the central source for all provider-related information for patients on Highmarks system. The new Highmark Provider Manualwaspublished on May 23, 2023. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Setting up access permissions Please note: When registering with NaviNet, you'll need to use the service address listed on file with Highmark BCBSWNY NOT a PO box, billing (unless it's the same as the service address) or personal address Click here to register your office for NaviNet; A Federal Tax ID number is required for registration This training is a 4-step process. Login to the provider portal. These trainings are a great way to give current staff helpful information about Highmark policies, programs and procedures. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. For Providers - Highmark Health Options Many changes will take effect \u003cstrong\u003eJuly 6, 2023\u003c/strong\u003e. PDF Provider Manual - Highmark Health Options Provider Tools and Educational Resources Behavioral Health Toolkit for Primary Care Physicians Resources to help provide behavioral health care for a range of diagnoses for Mental Health as well as Substance Use Disorder. Enrollment in Highmark Choice Company and Highmark Senior Health Company depends on contract renewal. Our legacy provider website will be decommissioned on February 1, 2023, at which point you will be redirected to the Highmark Provider Resource Center (PRC). Highmark Blue Shield, Highmark Benefits Group, Highmark Choice . The provider resources included below are meant to help you link the members you see to appropriate care in the most streamlined way possible to secure the best use of available benefits. Provider Resource Center 10% HR Consulting. Provider Resource Center Highmark Provider Manual - Provider Resource Center Only Providers who have claims linked to Letters can login. Forgot Password. Using the Highmark Provider Resource Center (PRC), Working Together During the Highmark Affiliation, Notice of Non-Discrimination and Translation Assistance. 2018 ACA Select Network; Highmark 2017; Highmark 2018: Important Product News; Highmark PRC Home; Legal Information; Message Center; Provider Consent Decree FAQs; Provider FAQ; Provider Orientation; Report Site Issues; Site Map . Highmark continually seeks ways to make its network credentialing process easier for our providers. Highmark has added several specialty providers to further augment our existing network to better serve our members. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. PCP AND MEDICAL SPECIALIST ACCESSIBILITY EXPECTATIONS table. We have redesigned the Highmark Provider Manual to make it easier for you to view and find important information, policies, and procedures for all providers participating in our networks in Delaware, New York, Pennsylvania, and West Virginia. 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 Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. Many changes will take effect \u003cstrong\u003eJuly 6, 2023\u003c/strong\u003e. This qualifying statement was in the Provider Manual on the HealthNow provider websites, but was inadvertently omitted when transitioned to the Highmark Provider Resource Center websites. In this article, you can find information on how to credential and enumerate. Due to inactivity, your browser session has expired. \u003ca href=\"https://content.highmarkprc.com/Files/NewsletterNotices/SpecialBulletins/sb-post-phe-provider-communication.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"\u003e\u003cstrong\u003eCLICK HERE\u003c/strong\u003e \u003c/a\u003efor the details.\u003c/p\u003e","longDescription":null,"visible":false,"archive":false,"liveStatus":2}], Request for Addition to Existing Assignment Account form, Facility Based Provider Affirmation Statement. All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. For additional details, view. Once you meet the program requirements, an authorized representative of your organization can complete and retain a copy of the attestation form above for your records. A Physician Dashboard Report is provided to all PCPs quarterly indicating individual members that are due or overdue for an EPSDT well-visit. Ly thng tin h thng b li! Highmark adheres to the Centers for Medicare and Medicaid Services (CMS) coverage determinations for Medicare Advantage (MA) membership. Since our affiliation with Highmark, we have been directing you to the Highmark Provider Resource Center (PRC)in our webpages and email communications. Note: If you are not yet contracted with Highmark and are interested in participating in our provider networks, you can start by selecting CREDENTIALING from the main menu on the left, and then choosing the appropriate option based on your provider type. Provider Resource Center The Provider Dashboard utilizes claims data to auto-generate a report which provides a network provider a snapshot of their panel of members in the EPSDT population. Provider Resource Center Use this form to add your Opioid Treatment Program Certificate to your provider file. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Other sections ofChapter 4cover PCPs, other specialists, ancillary providers and outpatient radiology and laboratory.
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