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.