Staying Up to Date With the Highmark Provider Manual
Ensure you are regularly reviewing the Highmark Provider Manual for our most recent guidance on:
- Participation Rules
- Credentialing/Recredentialing Criteria and Procedures
- Medical Record Criteria
- Requirements for 24/7 Coverage
Some recent noteworthy changes include:
- Chapter 3 Unit 2: Professional Provider Credentialing – updated the credentialing process throughout the unit and included NY Medicaid/Child Health Plus (CHP) instructions.
- Chapter 3 Unit 4: Organizational Provider Participation (Facility/Ancillary) – added guidance that FEP members do not have coverage for procedure code S9088.
- Chapter 4 Unit 2: Behavioral Health Providers – updated the levels of care for behavioral health providers and removed the requirement for Medical Directors to submit claims for PHPs/IOPs.
Provider News, Issue 4, April 2023 | © 2023 Highmark Blue Shield