Highmark to Phase Out Fillable PDF Forms

Starting Jan. 1, 2019, the fillable PDF forms located on Highmark’s online Provider Resource Center (PRC) will be discontinued. You will continue to have access to the electronic forms available on the PRC, which are easier to use and process faster and more efficiently than fillable forms.

The following table shows the electronic equivalents of the fillable forms.

Fillable Form	Electronic Form
Facility-Based Provider Affirmation Statement	Facility-Based Provider Affirmation Statement
Request for Assignment Account	Request for Assignment Account
Request for Addition/Deletion to Existing Assignment Account	Request for Addition/Deletion to Existing Assignment Account
Provider File Maintenance Request	Adding a Practice Address
Provider File Maintenance Request	Existing Address Change Form for Professional Providers
Provider File Maintenance Request	Provider Change Form

 

Electronic forms are available on the PRC under Forms > Provider Information Management Forms.