Staying Up to Date with the Highmark Provider Manual

Authorization 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:

  • Contact Information Tip Sheets updated
  • Types of Professional Providers Credentialed updated in Chapter 3, Unit 2
  • General Credentialing Criteria for Physician Assistants added to Chapter 3, Unit 2
  • Right Start information replaced with High-Risk Maternity Program
  • Medicare Advantage added for New York regions
  • Provider Service Phone Number added to the infertility benefit in Chapter 4, Unit 1
  • Clinical Services/Behavioral Health hours updated
  • Making a Determination of Coverage based on Medical Necessity for New York regions was added to Chapter 5, Unit 4


 

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