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 occurred in the following chapters and units:
  • Chapter 2, Unit 6: The BlueCard Program
  • Chapter 3, Unit 2: Professional Provider Credentialing
  • Chapter 5, Unit 4: Behavioral Health
  • Chapter 5, Unit 5: Denials, Adverse Benefit Determinations, Grievances, and Appeals
  • Chapter 5, Unit 6: Quality Management
  • Chapter 6, Unit 2: Electronic Claim Submission

To see the full list of recent changes, visit the Highmark Provider Manual Changes page.