Quick Links:
Manuals
Highmark Provider Manual
Medical Policy
Medical Policy
Medical Policies
Medicare Advantage Medical Policies
eSubscribe
Requiring Authorization
Pharmacy Policy Search
Message Center
Manuals
Highmark Provider Manual
Medical Policy Search
Medical Policy Search
Medical Policies
Medicare Advantage Medical Policies
Pharmacy Policy Search
Requiring Authorization
eSUBSCRIBE
Site Map
Care Management Programs
Advanced Imaging and Cardiology Services Program
AIS Home Visit Program
Care Management Programs
DIP Levels
Laboratory Management Program
Musculoskeletal Surgery and Interventional Pain Management Services Prior Auth Program
Physical Medicine Management Program
Post-Acute Care Management for Medicare Advantage Members
Prior Authorization/Notification Information - Radiology Management Program
Privileging Appeal Process - PA
Privileging Application and Requirements - Radiology Management - PA
Radiation Therapy Authorization Program
Radiology Management Program
Claims, Payment & Reimbursement
Clinical Information Requirements
Documentation Guidelines for Evaluation and Management Services
Electronic Data Interchange (EDI) Services
Guidelines for HUD/HUE
Highmark Coding Tips
Highmark Medical Policy
How are Medical Policies Developed? - PA
List of Procedure Codes Requiring NDC Information
Medical Policy
Medical Policy Department
Medical Policy Frequently Asked Questions (FAQs)
Medical Policy Update Newsletter
Medicare Advantage Medical Policy
Medicare Advantage Medical Policy Frequently Asked Questions (FAQs)
PAP Device Program
Procedure/Service Requiring Prior Authorization
Reimbursement Policy
Reimbursement Policy Archive
Credentialing
Professional Initial Credentialing Set Up
Behavioral Health Initial Credentialing Set Up
Organizational Initial Credentialing Set Up
Initial Credentialing Request Form
Credentialing Webinar
Education/Manuals
A Key Area of Focus to Combat Childhood & Adult Obesity
Advance Care Planning - PA
Article VIII of the Bylaws of Highmark Inc. and Highmark Blue Shield Review Committee Guidelines
Behavioral Health ACM Authorization Submission Manual
Behavioral Health Practice Resources
CAHPS®/QHP EES Survey Results
Childhood Obesity Physician Tool Kit
Chlamydia Testing in Young Women: Room for Improvement
Educational Resources - Member and Provider
First Priority Health Network Resources
Free cultural competency training
Geriatric Resource Binder
Health Care Disparities: An Overview
Health Equity & Quality Services
Health Literacy: A Closer Look
HEDIS
HEDIS Results - HBS
Highmark Blue Shield Office Manual
Highmark Facility Manual
Highmark Provider Glossary
Highmark Provider Manual
Highmark Provider Manual Appendix - PA
Highmark Provider Manual Archive
Highmark Provider Manual Tip Sheet Index
Improving Blood Pressure Control
Inventory Request Form
Medicare Advantage Member Evidence of Coverage Booklets
Office Site and Medical Record Evaluation Forms
Optimizing Treatment In The Patient With Rheumatoid Arthritis
PCP and OBGYN Practice Resources
Practice Site Resources
Preventive Health Guidelines
Provider Data Accuracy Compliance
Provider File Management: NaviNet Guide
SilverSneakers
What is Culturally Competent Health Care
Forms
Behavioral Health Forms
Certificate of Medical Necessity (CMN) for DME Providers
FEP Medical Health Forms
Miscellaneous Forms
Provider Information Management Forms
High Performance Networks
High Performance SNF Network
Select DME Network
Inter-Plan Programs
Blue Distinction Centers For Specialty Care Program
BlueCard Information Center
Electronic Provider Access (EPA) for Pre-Service Review
Medical Policy and Pre-certification Pre-authorization Information for Out-of-Area Members
Medicare Advantage PFFS Search
Newsletters/Notices
Clinical Views
e-Subscribe for Publications and Notifications
Facility Bulletins
Hot Topic Library
Hot Topic Library - 2016
Hot Topic Library 2013
Hot Topic Library 2014
Hot Topic Library 2015
Medical Policy Update Newsletter
Provider News
Special Bulletins & Mailings
North Eastern Pennsylvania Exclusive Information
NorthEastern Pennsylvania Exclusive Information
Pharmacy Program/Formularies
About ID cards - Information for Pharmacists PA & WV
Diabetes Medications Dosing Guide
Drug Utilization Review PA
Formulary Information
List of Procedure Codes Requiring NDC Information
Managed Prescription Drug Coverage (MRxC)
Medical Injectable Drug Program HBS
Medicare Formularies
Medicare Part B Drug Website
Medicare Part D Hospice Prior Authorization Information HBS
Pharmaceutical Management (Clinical Management Programs) HBS
Pharmacy Benefits Program HBS
Pharmacy Information
Pharmacy Policies - SEARCH
Prescription Drug Prior Authorization - PA
Process for Requesting Drug Coverage from a Pharmaceutical Management Program HBS
Program for Self-Administered Injectable or Oral Biotechnology Drugs
What is the Formulary?
Provider Training
Provider Orientation
Provider Training
Value-Based Reimbursement Programs
Adult BMI Assessment
All-Cause Readmissions: Medicare Advantage
Annual Wellness and Initial Preventative Physical Exam Rate
Breast-Cancer-Screening
Colorectal Cancer Screening
Comprehensive Diabetes Care: Eye Exam (retinal) Performed
Comprehensive Diabetes Care: HbA1c Control (<9%)
Comprehensive Diabetes Care: Medical Attention for Nephropathy
Controlling High Blood Pressure
Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis
Fall Risk Assessment - MA Stars
Medicare Advantage Stars
Medicare Advantage Stars About - PA WV Both
Medication Adherence for Cholesterol (Statins)
Medication Adherence for Diabetes Medication
Medication Adherence for Hypertension: Renin Angiotensin System Antagonists (RASA)
Medication Reconciliation Post Discharge
Medication Therapy Management
Osteoporosis Management in Women who had a Fracture
Statin Therapy: Cardiovascular Disease
Statin Therapy: Diabetes
Value-Based Reimbursement Programs Overview
Other Resources
Highmark 2017
Highmark 2018: Important Product News
Highmark 2019: Important Product News
Highmark PRC Home
Legal Information HBS
Message Center
Provider FAQ
Report Site Issues
Site Map
To Top