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 occurred in the following chapters and units:
  • Chapter 1, Unit 4: Highmark Member Information
  • Chapter 2, Unit 6: The BlueCard Program
  • Chapter 3, Unit 2: Professional Provider Credentialing
  • Chapter 4, Unit 1: PCPs and Specialists
  • Chapter 4, Unit 2: Behavioral Health Providers
  • Chapter 4, Unit 7: Durable Medical Equipment and Prosthetics
  • Chapter 5, Unit 1: Care Management Overview
  • Chapter 5, Unit 3: Medicare Advantage Procedures
  • Chapter 5, Unit 7: Value-Based Reimbursement Programs
  • Chapter 5, Unit 6: Quality Management
  • Chapter 6, Unit 8: Payment Review

To see the full list of recent changes, visit the Highmark Provider Manual Changes page.


 

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