Notifications for Providers

Several times annually, Highmark notifies providers of important policies and guidelines.
The following notification is for your information and reference.

See Highmark Provider Manual for Participation Rules; Credentialing/Recredentialing Criteria and Procedures; Medical Record Criteria; Provider Responsibilities; and 24/7 Coverage Requirements

In-network providers should consult the Highmark Provider Manual for information outlining the health plan’s network participation rules; credentialing/recredentialing criteria and procedures; medical record criteria; provider responsibilities; and 24/7 coverage requirements. The manual is available under Education/Manuals on Highmark’s online Provider Resource Center, which is accessible via NaviNet^® or under Helpful Links at highmarkbcbswv.com/ .

Information on these vital topics can be found in the following chapters and sub-units:

Provider network participation (including credentialing/recredentialing criteria and procedures, along with 24/7 coverage requirements:

• Chapter 3: Provider Network Participation, Unit 1: Network Participation Overview
• Chapter 3: Provider Network Participation, Unit 2: Professional Provider Credentialing
• Chapter 3: Provider Network Participation, Unit 3: Professional Provider Guidelines
• Chapter 3: Provider Network Participation, Unit 4: Organizational Provider Participation (Facility/Ancillary)

Provider responsibilities and guidelines:

• Chapter 4: Provider Responsibilities and Guidelines, Unit 1: PCPs and Specialists
• Chapter 4: Provider Responsibilities and Guidelines, Unit 2: Behavioral Health Providers
• Chapter 4: Provider Responsibilities and Guidelines, Unit 3: Facility-Specific Guidelines

Medical record criteria:

• Chapter 3: Provider Network Participation, Unit 3: Professional Provider Guidelines