Highmark strives to actively help providers identify members who can benefit from fully accessing their mental health/substance use disorder benefits in a timely manner.
The most critical obstacles that Highmark focuses on are getting the member’s attention, helping them to overcome the cultural and social barriers represented by stigma, and seeking care and treatment for mental health/substance use disorder conditions early in the course of the illness. Delays and care not received can significantly impact the member’s quality of life and experiences when treating other health issues.
Highmark has added several specialty providers to further augment our existing network to better serve our members. This includes new and innovative treatment delivery that makes the best use of telemedicine channels (synchronous and asynchronous), digital tools, multi-disciplinary approaches, health information presentation/delivery, and continuous contact with the member’s treatment.
The provider resources included below are meant to help you link the members you see to appropriate care in the most streamlined way possible to secure the best use of available benefits.
Behavioral Health Fax Number for Authorization Requests: 1-877-650-6112
For precertification or continued stay review requests for Behavioral Health treatment, please submit relevant clinical information via fax to 1-877-650-6112.
Submission of the complete medical record may slow down the process and is not an efficient way to communicate the clinical need for an admission or continued stay review.
Please fax the relevant clinical information to support the treatment request using your own fax format as needed.
Behavioral Health Phone Number: 1-800-258-9808
Telemedicine and Virtual Visits
Provider Tools and Educational Resources
- Behavioral Health Toolkit for Primary Care Physicians
Resources to help provide behavioral health care for a range of diagnoses for Mental Health as well as Substance Use Disorder. Included are best practice recommendations, screening tools, and clinical practice guidelines.
- axialHealthcare (now known as Wayspring)
Connects patients, providers and health plans with an end-to-end platform that covers the entire substance use spectrum. Highmark has collaborated with this program to offer a wide range of tools and resources to providers in DE, PA and WV that aim to support the health and safety of patients on opioids and other controlled substances.
Behavioral Health Forms
Behavioral Health Practice Resources
The link above includes Behavioral Health specific sample treatment records, sample policies, and sample office forms and protocols intended for use to assist in office site evaluations and treatment record documentation compliance.
Provider Responsibilities and Guidelines
This section of the Highmark Provider Manual outlines Behavioral Health provider responsibilities and guidelines. Other sections of Chapter 4 cover PCPs, other specialists, ancillary providers and outpatient radiology and laboratory.
Behavioral Health Automated Care Management Authorization Submission Manual
Last updated on 4/5/2023 9:14:57 AM