Faxes Being Phased Out; Prior Auth Requests Must Be Submitted via Availity Effective Oct. 1 Effective Oct. 1, 2024, Highmark will transition to an exclusively digital prior authorization process for all regions. To streamline member care and expedite approvals — while also reducing unnecessary expenditures — all medical prior authorization requests must be submitted through the Availity® provider portal. Pharmacy requests should continue to be submitted via CoverMyMeds.

*West Virginia providers must continue to submit via the portal as of July 1, 2024, per WV code 33-24-7s.

Highmark had previously announced that faxes would be going away this year in April Provider News.

This change to electronic submissions offers significant benefits:

  • Faster Processing: Availity portal submissions are processed up to 75% faster than traditional methods, with some approvals available instantly.

  • Enhanced Efficiency: Eliminating faxed requests simplifies the process for both providers and Highmark.

  • Increased Cost Savings. Faxes are more labor-intensive and expensive to process compared to submissions via the provider portal.

Today’s Technology

“Electronic submissions for prior authorization requests are the industry standard,” said Dr. Timothy Law, Chief Medical Officer and Vice President of Integrated Care Delivery for Highmark. “We are trying to be a conduit to appropriate care rather than a roadblock, and electronic submissions allow us to do that for our providers and our members.”

Some Requests Immediately Approved

Submitting authorization requests via the Availity portal not only expedites processing but also results in some procedures receiving immediate approvals, including the following:

  • 30520 – Septoplasty or Submucous Resection, with or without cartilage scoring contouring or replacement with graft.
  • 31255 – Nasal/Sinus Endoscopy, surgical; with ethmoidectomy, total (anterior and posterior).
  • 43775 – Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (i.e., sleeve gastrectomy).
  • 42831 – Adenoidectomy, primary; age 12 or over.
  • 95811 – Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation.

Note: The use of proper diagnosis codes is required.

Resources

On the Provider Resource Center, there are guides and videos that will walk you through the process of submitting electronic authorization requests via Availity:


 

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