Highmark is encouraging all providers to submit prior authorization requests electronically in preparation of a new West Virginia law (Senate Bill 267*), which goes in effect July 1, 2024. Submitting electronically via the provider portal — either Availity^® or NaviNet^® — allows for faster reviews and greater transparency around the status of authorization requests.

On December 1, 2023, Highmark will remove prior authorization forms from the West Virginia Provider Resource Center (PRC). The removal of the forms will not impact a provider’s ability to submit a prior authorization request by phone or fax. However, beginning July 1, 2024, all authorization requests will need to be submitted via our provider portal — which is a requirement of West Virginia SB 267*.

Education and Training

Highmark will conduct outreach to ensure providers know how to successfully use the provider portal for authorization requests as well as workflows within the Predictal™ Auth Automation Hub — which enables offices to submit, update, and query these authorization requests.

The following authorization submission user guides are currently available on the PRC:

• Non-Urgent Inpatient Authorization Submission Guide
• Urgent Inpatient Authorization Submission Guide
• Outpatient Authorization Submission Guide
• Helion Arc Authorization Submission Guide

For more information, see the recent Special Bulletin by clicking here.

*West Virginia Senate Bill 267 requires prior authorizations to be submitted via an electronic portal. For more information on the bill, visit https://www.wvlegislature.gov.