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Care Management Programs

• Advanced Imaging and Cardiology Services Program
• AIS Home Visit Program
• DIP Levels
• Laboratory Management Program
• Musculoskeletal Surgery and Interventional Pain Management Services Prior Auth Program
• Physical Medicine Management Program
• Post-Acute Care Management for Medicare Advantage Members
• Prior Authorization/Notification Information - Radiology Management Program
• Privileging Application and Requirements - Radiology Management - WV
• Radiation Therapy Authorization Program
• Radiology Management Program
• Radiology Management Program Info
• Radiology Management Program WV Clinical Guidelines

Claims, Payment & Reimbursement

• Documentation Guidelines for Evaluation and Management Services
• Electronic Data Interchange (EDI) Services
• Guidelines for HUD/HUE
• Highmark Coding Tips
• List of Procedure Codes Requiring NDC Information
• Medical Policy
• Medical Policy Update Newsletter
• Procedures/Service Requiring Prior Authorization
• Reimbursement Policy
• Reimbursement Policy Archive

COVID-19

• COVID-19 (Coronavirus) Information
• Billing/Coverage for COVID-19
• Billing/Coverage for COVID-19
• Clinical/Operational Updates
• Talking to Your Patients
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Credentialing

• Organizational Behavioral Health Initial Credentialing Set Up
• Organizational Initial Credentialing Set Up
• Organizational Credentialing Forms
• Professional Initial Credentialing Set Up
• Initial Credentialing Request Form

Education/Manuals

• axialHealthcare Substance Use Risk and Recovery Programs
• Behavioral Health ACM Authorization Submission Manual
• Behavioral Health Practice Resources
• Behavioral Health Toolkit for Primary Care Physicians
• CAHPS®/QHP EES Survey Results
• Clinical Programs and Services for Highmark Members
• Educational Resources - Member and Provider
• HEDIS Results
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• Highmark Provider Manual
• Highmark Provider Manual Appendix - WV
• Highmark Provider Manual Archive
• Highmark Provider Manual Tip Sheet Index
• Improving Blood Pressure Control
• Inventory Request Form
• Inventory Request Form
• Medicare Advantage Member Evidence of Coverage Booklets
• Office Site and Medical Record Evaluation Forms
• Optimizing Treatment In The Patient With Rheumatoid Arthritis
• PCP and OBGYN Practice Resources
• Population Health University
• Practice Site Resources
• Preventive Health Guidelines
• Provider Data Accuracy Compliance
• Provider File Management: NaviNet Guide
• SilverSneakers
• Transitions of Care
• WVFH Medicaid Primary Care Incentive Program
• WVFH Provider Manual

Forms

• Behavioral Health Forms
• Certificate of Medical Necessity (CMN) for DME Providers
• FEP Medical Health Forms
• Medical Injectable Drugs
• Miscellaneous Forms
• Pharmacy Prior Authorization Forms
• Professional Initial Credentialing Set Up
• Provider Information Management Forms

Inter-Plan Programs

• Blue Distinction Centers For Specialty Care Program
• BlueCard Information Center
• Medical Policy and Pre-certification Pre-authorization Information for Out-of-Area Members
• Medicare Advantage PFFS Search

Newsletters/Notices

• COVID-19 (Coronavirus) Information for Providers
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• Facility Bulletins (2014 & older)
• Helion Bulletin
• Hot Topic Library
• Hot Topic Library - 2014
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• Hot Topic Library - 2016
• Medical Policy Update Newsletter
• Provider News
• Special Bulletins & Mailings

Pharmacy Program/Formularies

• Diabetes Medications Dosing Guide
• Formulary Information
• Formulary Updates
• Free Market Health
• Hemophilia and Bleeding Disorder Drug Program
• List of Procedure Codes Requiring NDC Information
• Managed Prescription Drug Coverage (MRxC)
• Medical Injectable Drug Program - WV
• Medicare Formularies
• Pharmaceutical Management (Clinical Management Programs) WV
• Pharmacy Benefits Program WV
• Pharmacy Information
• Pharmacy Policies - SEARCH
• Prescription Drug Prior Authorization - WV
• Process for Requesting Drug Coverage from a Pharmaceutical Management Program
• Program for Self-Administered Injectable or Oral Biotechnology Drugs
• What is the Formulary?

Product Information

• Product Information

Provider Training

• Provider Orientation
• Provider Training

Value-Based Reimbursement Programs

• Medicare Advantage Stars
• Medicare Advantage Stars About - PA WV PUBLIC
• Value-Based Reimbursement Programs Overview

Other Resources

• Highmark 2018: Important Product News
• Highmark West Virginia PRC Home
• Legal Information - WV
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