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 2, Unit 4: Benefit Plan Programs
- Chapter 5, Unit 2: Authorizations
- Chapter 5, Unit 5: Denials, Adverse Benefit Determinations, Grievances, and Appeals (Applicable to Pennsylvania Providers Only)
- Chapter 7, Unit 6: Professional Regulations (Applicable to Pennsylvania Providers Only)
To see the full list of recent changes, visit the Highmark Provider Manual Changes page.
Provider News, Issue 12, December 2023 | © 2023 Highmark Blue Shield of Northeastern New York