Are You Referring To Providers In Your Patients’ Networks?

If you need to refer patients to other providers, such as specialist physicians, or for physical therapy, imaging services, or laboratory tests, keep in mind that referring them to providers who participate in their health plans’ networks means a lower likelihood of denied claims and higher out-of-pocket expenses for your patients.

We’d also like to remind you that Highmark’s Network Use Policy requires you to utilize in-network providers to perform any services on behalf of members whenever in-network providers are available.

If you have previously sent members to out-of-network providers when in-network providers are available, immediately stop sending members to those providers.

Confirm Patients’ Networks Before Making Referrals

Before you refer your patients for care, confirm your members’ networks and benefits in NaviNet®. A self-service guide with instructions for confirming networks in NaviNet is available on the Provider Resource Center under PROVIDER TRAINING > Provider Training > NAVINET SELF SERVICE GUIDES.

Remind Your Patients about Finding Network Providers

If your patients need help finding network providers, remind them that they can do so in one of the following ways:

  • Using Find a Doctor or Rx on their member websites. Your patients can use Find a Doctor or Rx without logging in, but if they log in, their results will be more specific to their health plans’ networks.
  • Calling the toll-free number on the back of their member ID cards

Review the Network Use Policy

You can review the Network Use Policy in the Highmark Provider Manual’s Chapter 3, Unit 1, section “Directing Care to Network Providers.” Visit the Provider Resource Center and click MANUALS in the top navigation bar, and click the Highmark Provider Manual link.