Behavioral Health Forms


In anticipation of an upcoming change in West Virginia Law (Senate Bill 267), Highmark is encouraging all providers to submit prior authorization requests electronically using our provider portal (either Availity® or NaviNet®). On December 1, 2023, Highmark removed prior authorization forms from the West Virginia Provider Resource Center (PRC).

For more information, read our Special Bulletin.


This page contains Behavioral Health forms for providers to use when communicating with Highmark.

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.

For FEP Members Only

Residential Treatment Center (RTC) must be accredited by a nationally recognized organization and licensed by the state, district, or territory to provide residential treatment for medical conditions, mental health conditions, and/or substance abuse. 

Pre-admission Requirements:

  • Precertification prior to admission
  • A preliminary treatment plan and discharge plan must be developed and agreed to by the member, provider (residential treatment center (RTC), and case manager in the Local Plan where the RTC is located prior to admission.
  • Member must be enrolled and participating in case management through the Local Plan when the care is medically necessary for treatment of a medical, mental health, and/or substance abuse condition.

FEP Nondiscrimination Notice

Last updated on 12/1/2023 3:49:53 PM


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