Notifications for Providers
Several times annually, Highmark notifies providers of important policies and guidelines.
The following notification is for your information and reference.
See Highmark Provider Manual for Participation Rules; Credentialing/Recredentialing Criteria and Procedures; Medical Record Criteria; Provider Responsibilities; and 24/7 Coverage Requirements
In-network providers should consult the Highmark Provider Manual for information outlining the health plan’s network participation rules; credentialing/recredentialing criteria and procedures; medical record criteria; provider responsibilities; and 24/7 coverage requirements. The manual is available under Education/Manuals on Highmark’s online Provider Resource Center, which is accessible via NaviNet® or under Helpful Links at highmarkblueshield.com .
Information on these vital topics can be found in the following chapters and sub-units:
Provider network participation (including credentialing/recredentialing criteria and procedures, along with 24/7 coverage requirements:
- Chapter 3: Provider Network Participation, Unit 1: Network Participation Overview
- Chapter 3: Provider Network Participation, Unit 2: Professional Provider Credentialing
- Chapter 3: Provider Network Participation, Unit 3: Professional Provider Guidelines
- Chapter 3: Provider Network Participation, Unit 4: Organizational Provider Participation (Facility/Ancillary)
Provider responsibilities and guidelines:
- Chapter 4: Provider Responsibilities and Guidelines, Unit 1: PCPs and Specialists
- Chapter 4: Provider Responsibilities and Guidelines, Unit 2: Behavioral Health Providers
- Chapter 4: Provider Responsibilities and Guidelines, Unit 3: Facility-Specific Guidelines
Medical record criteria:
- Chapter 3: Provider Network Participation, Unit 3: Professional Provider Guidelines
Provider News, Issue 3, 2018 | © 2018 Highmark Blue Shield