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 additions include:

  • Davis Vision vendor information has been added to Chapter 5, Unit 1

  • New York Medicaid and CHP information has been added to Chapter 2, Unit 3

  • West Virginia and New York guidance on Independent Review Organization fees has been added to Chapter 6, Unit 8

  • Additional Guidance on Submitting Claims with More than 36 Diagnosis Codes has been added to Chapter 5, Unit 6


 

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