Staying Up to Date With the Highmark Provider Manual

Ensure you are regularly reviewing the Highmark Provider Manual for our most recent guidance on:

  • Participation Rules
  • Credentialing/Recredentialing Criteria and Procedures
  • Medical Record Criteria
  • Requirements for 24/7 Coverage

Some recent noteworthy changes include:

  • Chapter 3 Unit 2: Professional Provider Credentialing – updated the credentialing process throughout the unit and included NY Medicaid/Child Health Plus (CHP) instructions.
  • Chapter 3 Unit 4: Organizational Provider Participation (Facility/Ancillary) – added guidance that FEP members do not have coverage for procedure code S9088.
  • Chapter 4 Unit 2: Behavioral Health Providers – updated the levels of care for behavioral health providers and removed the requirement for Medical Directors to submit claims for PHPs/IOPs.