Medicaid Provider Manual
Provider Manual

Provider Rebranding Reference Materials
Highmark Wholecare New Branding - YouTube Video
Highmark Wholecare Rebranding FAQs for Providers

HealthHelp Reference Material
HealthHelp Reference Material

Drug Exception Form
Drug Specific Prior Authorization Forms - Submit e-PA Requests via CoverMyMeds
Home Infusion Drug Request Form
Oncology and Supportive Therapy Request Form Submit requests via Navinet.

After Hours Services
BetterDoctor Provider FAQ
CARC and RARC Adjustment Code Crosswalk 
Certification for Expedited Review Form
Clinical Services Referral Guide
CMS UB04 Form
CMS-1500 Form
Consent for Provider to File a Grievance for Member
Consent to Release Health Information to Coordinate Physical and Behavioral Health Care
Cultural Competency Data Form
Electronic Billing Companion Document
EPSDT Billing Document
FQHC RHC Billing Guide
How to Use the Provider Portal Search Tool
Language Form
Lead Screening Analysis Form
MA30 - Hysterectomy English
MA30 - Hysterectomy Spanish
MA31 - Sterilization Form - English
MA300X - Medical Assistance Provider Order Forms for Providers
Maternity Outcome Authorization Form
Member Benefit Packages / Co-Pay Matrix
Member Outreach Form
Obstetrical Billing Guide
OB Care Enhancements Provider Training
Obstetrical Needs Assessment Form (ONAF)
Optum OB User Guide
Opioid - CDC Guideline for Prescribing Opioids for Chronic Pain
Outpatient Program Exceptions Request – Please submit via Navinet.
Pediatric Telehealth Guide
PNC Echo UI Users Guide
Practice/Provider Change Request Form
Provider Self-Audit Overpayments Form
Refund Form
School Vaccination Requirements
Structured Screening for Developmental Delays and Autism Spectrum Disorders 

Last updated on 5/1/2024 9:07:38 AM


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