IN THIS ISSUE:

Case Management Referrals: Caring for Members with Complex Conditions

Highmark encourages providers to identify members who could benefit from coordinated case management services. You can submit referrals for Clinical Care and Wellness (CC&W) case management programs from Availity^®.

This feature will help connect Highmark members who have chronic conditions and complex medical needs to the right clinical support.

To access this feature:

Log into Availity.
Select the state where you practice.
Click Payer Spaces on the task bar and choose your Highmark plan.
From Payer Spaces, scroll down to Applications and click Predictal.
From the Predictal™ Auth Automation Hub, hover over the left navigational panel and select Case Management Referral.
Acknowledge the information needed to submit the form and Continue. This will take you to the Program Referral Submission for member selection.
Follow the remaining steps to create and submit the referral.

Using this feature in Availity also simplifies and expedites the overall case management referral process, while reducing the administrative burden for providers.

Additional Resource

To learn more about making case management referrals, watch the Case Management Referral Process (Predictal via Availity), which is available on the Provider Resource Center (PRC).

Once on the PRC, choose PRIOR AUTHORIZATION from the left menu, click Procedures/Service Requiring Prior Authorization, and then scroll down to the Videos section.