Provider Orientation

WELCOME TO HIGHMARK BLUE CROSS BLUE SHIELD!

If you are a newly contracted provider, or a new employee of a network provider's office or facility, we would like to introduce you to the many resources we make available to help you in your interactions with Highmark and our members. 

Get to Know Us:

Start Working With Us:

  • Register for the provider portal, Availity Essentials – All network providers are required to register for our provider portal, Availity Essentials, to submit transactions to Highmark. Review the Availity section of the Provider Resource Center (PRC) for more information regarding training and support.
  • Enroll in Electronic Funds Transfer (EFT) and ERAs (Electronic Remittance Advices) – After becoming Availity-enabled, providers must also enroll in electronic funds transfer and paperless Electronic Remittance Advices. To do this, please contact your Provider Account Liaison.
    • More information may be found in the Highmark Provider Manual, Highmark Electronic Transaction Requirements (Chapter 1, Unit 3).
  • Provider Communications – Don’t miss important network information. Have it sent straight to your inbox by signing up to receive our monthly Provider Newsletter and e-mail notifications regarding important news and information here.
  • Tool and Resources – The Provider Resource Center (PRC) is the central location for helpful information such as:
    • The Highmark Provider Manual
      • BlueCard (Chapter 2, Unit 6)
      • Fraud Prevention (Chapter 6, Unit 8)
    • Important Announcements and Updates
    • Prior Authorization Requirements
    • Claims & Reimbursement Policies – Please reference the CLAIMS, PAYMENT & REIMBURSEMENT section in the left-hand menu on this site.
    • Medical Policy
    • Pharmacy Policy
    • Forms
    • Provider Newsletters
      • Reference the NEWSLETTERS/NOTICES section in the left-hand menu on this site to view past publications.
  • Provider and Clinical Services: Our PRC and provider portal, Availity, are the best options to find critical information. If you need something that cannot be self-serviced, you may contact customer service advocates using the Contact Information for your particular region.

Provider Training:

Please review our Provider Training page for additional helpful information about Highmark policies, programs, and procedures.

Preventive Health Guidelines:

Highmark continually strives to enhance the quality of care and service to our members. One of the ways this is accomplished is via the Highmark Preventive Health Guidelines. The guidelines are reviewed annually and updated to ensure they remain current with national guidelines, as well as with national, regional and local standards of medical care. The guidelines are distributed to the practitioner community as a reference tool to encourage and assist you in planning your patients’ care.

  • Coverage of the preventive/wellness benefits are subject to the terms of the member’s benefit plan.

To help make the information more accessible and convenient for you, the complete set of Preventive Health Guidelines are available here on the Provider Resource Center under EDUCATION/MANUALS. 

Provider Directory:

And finally, please be sure to report any changes to us regarding your office, facility, or participating care providers! Visit our Provider Data Accuracy Compliance page for requirements for accurate, up-to-date provider data in our Provider Directory and instructions on how to make any changes to your information on file with us.

The Provider Data Maintenance (PDM) and Provider File Management (PFM) guides are included there, too, to assist professional providers in reporting changes via Availity and/or NaviNet. And a link to the Highmark Facility/Ancillary Change Form is provided on the page for our participating facilities and ancillary providers.

The Provider Data Accuracy Compliance page is always available under EDUCATION/MANUALS in the left menu.

Thank you for your support and for providing high-quality care to our members, your patients. Welcome to Highmark - we look forward to working with you!


Note: If you are not yet contracted with Highmark and are interested in participating in our provider networks, you can start by selecting CREDENTIALING from the left-hand website menu

You can also find participation information in Chapter 3 of the Highmark Provider Manual. To access the manual, select MANUALS on the Quicklinks Bar located at the top of the Provider Resource Center. Contact Provider Services in your service area with any questions. 

Last updated on 2/1/2024 9:40:52 AM

 

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