Introducing a new provider resource experience that simplifies getting you the information you need, when you need it. You’re invited to visit an early release of our new site; try it out at providers.highmark.com. Your feedback is appreciated as we work to complete the experience.

Physical Medicine Management

Utilization management (UM) of outpatient physical medicine services — physical therapy, occupational therapy, and manipulation services — is Highmark-managed as of December 4, 2023.

 

The preferred — and fastest — method to submit preauthorization requests and receive approvals is the online provider portal, Availity Essentials.

Reference Materials

 

Instructional Videos

Click the links below to view the videos. If you experience an issue, please refresh your browser. If the issue persists, contact resourcecenter@email.highmark.com.

Availity

 

Authorization Requirements

For additional information and resources on submitting authorizationsCLICK HERE.

 

High Performing Providers

The High Performing Provider (HPP) designation is replacing the former Pathways Program effective January 1, 2025, for providers in all Highmark service areas. It is designed to give Highmark a formal process and framework for identifying and rewarding high-performing providers based on a defined set of metrics, allowing qualifying providers to have greater self-management.

For more information, read our Frequently Asked Questions.

 

What is Helion?

Helion is a health care technology and services company that helps payers cultivate high-performing networks while empowering providers to operate at their best — and in doing so, help patients heal better.

You can learn more about Helion here.

Last updated on 5/15/2024 4:13:48 PM

 

To Top