Medicaid Provider Manual Provider Manual Provider Rebranding Reference Materials Highmark Wholecare New Branding - YouTube Video Highmark Wholecare Rebranding FAQs for Providers
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PHARMACY FORMS 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.
GENERAL PROVIDER FORMS & REFERENCES After Hours Services BetterDoctor Provider FAQCARC 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 GuidePNC Echo UI Users Guide Practice/Provider Change Request FormProvider Self-Audit Overpayments Form Refund Form School Vaccination Requirements Structured Screening for Developmental Delays and Autism Spectrum Disorders
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Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration.
Highmark adheres to the Centers for Medicare and Medicaid Services (CMS) coverage determinations for Medicare Advantage (MA) membership. You're being redirected to the CMS search site.