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:

Removal of NaviNet
Highmark finalized changes to the Provider Manual related to the provider portal transition from NaviNet and HEALTHeNET (NY) to Availity. NaviNet and HEALTHeNET (NY) access for providers ended on April 26, 2024.

Vendor Update
All references to naviHealth in the Provider Manual have been changed to Home & Community Care Transitions to reflect the company's name change. Home & Community Care Transitions is a third-party vendor used by Highmark for post-acute care services for Highmark's Medicare Advantage members in Pennsylvania and West Virginia.

Additional changes occurred in the following chapters and units:
  • Chapter 3, Unit 2: Professional Provider Credentialing
  • Chapter 5, Unit 5: Denials, Adverse Benefit Determinations, Grievances, and Appeals
  • Chapter 6, Unit 4: Professional (1500/837P) Reporting Tips

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


 

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