Authorization Updates

AuthorizationDuring the year, Highmark adjusts the List of Procedures and Durable Medical Equipment (DME) Requiring Authorization. For information regarding authorizations required for a member’s specific benefit plan, providers may:

  • Call the number on the back of the member’s card,
  • Check the member’s eligibility and benefits via NaviNet® , or
  • Search BlueExchange through the provider’s local provider portal.

These changes are announced in the form of Special Bulletins posted on Highmark’s Provider Resource Center (PRC). The most recent Bulletins regarding prior authorization are below:

Medical Injectable/Specialty Drug Authorization Submissions

In addition, the PRC has a variety of educational resources available regarding the authorization automation process, including:

To access these resources, select AUTHORIZATIONS from the left menu and then click Procedures/Service Requiring Prior Authorization. Once on the page, scroll down to down the Obtaining Authorizations section.

To view the full List of Procedures/DME Requiring Authorization, click REQUIRING AUTHORIZATION in the gray bar near the top of the PRC homepage.

Once redirected to the Procedures/Service Requiring Authorization page, click View the List of Procedures/DME Requiring Authorization under PRIOR AUTHORIZATION CODE LISTS.

Please note that the Highmark member must be eligible on the date of service and the service must be a covered benefit for Highmark to pay the claim.

NaviNet® is the preferred method for:

  • Checking member benefits and eligibility
  • Verifying whether an authorization is needed
  • Obtaining authorization for services