Authorization Updates
During 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.
Authorization 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 listed below:
Effective Date(s) |
Title |
October 20, 2022 |
Authorization Letters Available in NaviNet for Inpatient Services |
November 1, 2022 |
Prior Authorization No Longer Needed for Glimepiride and Glyburide |
November 7, 2022 |
Authorizations Section Added To Provider Resource Center |
November 18, 2022 |
Enhancements to eviCore Authorization Process |
November 23, 2022 |
Outpatient Services, Ancillary, DME And eviCore Authorizations Routed to New Utilization Management Tool |
December 1, 2022 |
New Go-Live Date! Authorizations Required for OOA And OON Musculoskeletal, Genetic Testing, and Radiation Oncology Services |
December 9, 2022 |
Echocardiogram Code to Be Removed From Prior Authorization List |
December 31, 2022 |
Sunsetting: WholeHealth Living’s Rapid Response System Interactive Voice Response Option For Authorizations |
February 2023 |
MCG Chosen as Utilization Management Clinical Criteria Vendor |
January 1 and April 1, 2023 |
Upcoming Prior Authorization Changes |
March 1, 2023 |
Two Injectables to Require Prior Authorization Beginning March 1, 2023 |
To view the full List of Procedures/DME Requiring Authorization, click Requiring Authorization in the gray bar near the top of the PRC homepage.
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
The new Authorizations section on the PRC features forms and a complete list of procedures and services requiring authorization. To access the section, go to the PRC and click on
AUTHORIZATIONS from the left menu.
Provider News, Issue 6, 2022 | © 2022 Highmark Blue Cross Blue Shield West Virginia