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.

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.