Medicare Assured 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

Medicare Assured Provider Forms and Reference Material
CMS Standardized Part D Hospice Information Drug Request Form
Home Infusion Drug Request Form
Medicare Drug Exception Form
Oncology and Supportive Therapy Request Form   Submit requests via Navinet.
Second-Level Pharmacy Pricing Dispute Resolution Request Form
Discharge Form
Inpatient Authorization Request Form
Inpatient Substance Use Authorization Request Form
Outpatient Authorization Request Form
2023 Highmark Wholecare Benefits
After Hours Services
Appointment of Representative Form
Annual Wellness Visit Tools and Reference Materials
BetterDoctor Provider FAQ
CARC and RARC Adjustment Code Crosswalk 
Care for Older Adults (COA) Form
Cataract Removal Questionnaire
Clinical Services Referral Guide
CMS-1500 Form
CMS UB-04 Form
Consent to Release Health Information to Coordinate Physical and Behavioral Health Care
Cultural Competency Data Form
How to Use the Provider Portal Search Tool
ICD-10 Submitter-Provider Quick Start Guide
In-Service Materials
Language Form
Late Notification FAQ - Medicare
Living Will Declaration
Maternity Outcomes Authorization Form
Medicare Outpatient Observation Attestation
Medicare Outpatient Observation Notice
Medicare Outpatient Observation Notice Instructions
Member Outreach Form
Model of Care
Non-Participating Provider Complaint Form
Obstetrical Needs Assessment Form (ONAF)
Opioid - CDC Guideline for Prescribing Opioids for Chronic Pain
Optum OB User Guide
Outpatient Program Exceptions Request – Please submit via Navinet.
PNC Echo UI Users Guide
Practice/Provider Change Request Form
Provider Self-Audit Overpayments Form
Refund Form
Waiver of Liability Statement Form
Last updated on 4/24/2024 11:57:21 AM


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