Self-Service Tools for Authorization Status

Has it been a while since you tried using our provider portal or Interactive Voice Response (IVR)? Highmark continues to enhance its self-service tools to deliver a simpler, better coordinated experience for providers. The provider portal and IVR can help providers reduce administrative costs, improve office workflows, and assist in the collection of claim payments.

Starting November 13, 2023, we are encouraging providers to use these tools as the primary way to check authorization status and submit authorizations for the quickest answers/determinations.

Provider Portal

Helpful Resources

Highmark offers guides for various authorization types located on its Provider Resource Center. Choose Authorizations in the left-hand navigation bar.

Availity shares recorded trainings — including how to navigate to Predictal — by logging into Availity Essentials and then choosing Help & Training > Get Trained.

Availity®

Providers who currently use Availity Essentials for other payers will now be able to access Highmark in the regions in which they are contracted. (Providers who are newly contracted with Highmark may also register to use Availity at this time.)

You can easily check the status of your authorization or submit an authorization within Availity by following these steps:

  • Choose your state.
  • Click Payer Spaces in the navigation bar.
  • Select the Highmark logo.
  • Under Applications in the Highmark Payer Space, click Predictal™.

More information about the Availity transition can be found on the Provider Resource Center. Click Availity in the left-hand navigation bar.

NaviNet®

If you are not currently registered with Availity to transact with other payers, you can continue to check authorization status or submit an authorization in NaviNet until February 5, 2024, when your access to Availity will begin. In the meantime, you can check authorization status in NaviNet by following these steps:


Check Authorization Status

  • Click Auth Inquiry and Reports in the left-hand navigation under Workflows for this Plan.
  • Select Auth Inquiry.
  • Search for the authorization by member, date of service, or request ID.
  • View the authorization status by clicking on the authorization number and checking the Case Determination field.

Submit Authorization

  • Click Authorization Submission in the left-hand navigation under Workflows for this Plan.
  • Complete the fields on the NaviNet screen – selecting the appropriate Category and Service
  • You will be routed to Predictal to complete the authorization.

Interactive Voice Response (IVR) System

Highmark’s automated, interactive Voice Response (IVR) telephone system is available 24 hours a day, 7 days a week, and allows providers to inquire about authorization status.

  • Call the Provider Service Center for your region.
  • Enter the provider’s NPI number.
  • Enter the member’s Highmark ID or Social Security number.
  • Enter or say the member’s birthdate.
  • Say “Authorization.”
  • Say “Check Status” press “1.”
  • Enter authorization reference number (skipping any letters or symbols).

IVR Tip – Have Your Reference Number Ready

If you used the portal for your original authorization request, you obtained the reference number at the end of your submission.

  • If you phoned in, your Provider Service Representative provided you with a reference number.
  • If your original authorization request was received via fax, you will receive a fax notification following your submission with the reference number for your request.

Highmark’s Provider Resource Center

More information about the end-to-end authorization process, including workflow guides, may be found on our Provider Resource Center (PRC). Look under AUTHORIZATIONS > Procedures/Service Requiring Authorization. You will also find details regarding the Availity transition on the PRC.


 

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