During the year, Highmark adjusts the List of Procedures/DME Requiring Authorization, which includes outpatient procedures, services, durable medical equipment (DME), and drugs that require authorization for our members.
These changes are announced in the form of Special eBulletins that are posted on our online Provider Resource Center (PRC). These Special eBulletins are communicated as Hot Topics on the PRC and are archived under Newsletters/Notices > Special Bulletins & Mailings.
To view the List of Procedures/DME Requiring Authorization, click Requiring Authorization in the gray bar near the top of the PRC homepage. To search for a specific procedure code within the list, press the “Control” and “F” keys on your computer keyboard, enter the procedure code, and press “Enter.” For up-to-date information on procedures that require authorization or to view the current list of procedure codes, visit the PRC, accessible via NaviNet® or under Helpful Links on our website.
Please note that the Highmark member must be eligible on the date of service and the service must be a covered benefit in order for Highmark to pay your claim.
You may use NaviNet or the applicable HIPAA electronic transactions to:
If you don’t have NaviNet or access to the HIPAA electronic transactions, please call Clinical Services to obtain an authorization for services.