During the year, Highmark adjusts the List of Procedures and Durable Medical Equipment (DME) Requiring Authorization. For information regarding authorizations required for a member’s specific benefit plan, providers may:
Effective Date(s) | Title |
November 7, 2022 | Authorizations Section Added To Provider Resource Center |
November 18, 2022 | Enhancements to eviCore Authorization Process |
November 30, 2022 | Authorization Changes Postponed for MSK Procedures, Molecular and Genomic Testing, and Radiation Services |
December 9, 2022 | Echocardiogram Code to Be Removed From Prior Authorization List |
January 1, 2023 | 2023 Medicare Advantage Drug Formulary and Preauthorization Changes |
February 2023 | MCG Chosen as Utilization Management Clinical Criteria Vendor |
January 1 and April 1, 2023 | Upcoming Prior Authorization Changes |
March 1, 2023 | Two Injectables to Require Prior Authorization Beginning March 1, 2023 |
To view the full List of Procedures/DME Requiring Authorization, click Requiring Authorization in the gray bar near the top of the PRC homepage.
The Highmark member must be eligible on the date of service and the service must be a covered benefit for Highmark to pay the claim.
NaviNet® is the preferred method for: