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

Recent noteworthy changes occurred in the following sections:
  • Chapter 1, Unit 3: Electronic Solutions: EDI and Availity
  • Chapter 1, Unit 4: Highmark Member Information
  • Chapter 2, Unit 6: The BlueCard Program
  • Chapter 4, Unit 1: PCPs and Specialists
  • Chapter 4, Unit 2: Behavioral Health Providers
  • Chapter 5, Unit 6: Quality Management
  • Chapter 6, Unit 2: Electronic Claim Submission
  • Chapter 7 – Appendix > Chapter 7, Unit 6: Professional Regulations

For detailed descriptions of these recent changes, visit the Highmark Provider Manual Changes page.


 

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