For Highmark Blue Cross Blue Shield members in commercial plans, providers will need to request authorization for outpatient physical medicine and home health services, effective April 1, 2024.

This change was announced in our October 2023 Provider News. Originally, the new prior authorization requirements were scheduled to be implemented Jan. 1, 2024, but were postponed due to the transition to Highmark’s new provider portal.

The following outpatient services — for members in commercial plans — will require prior authorization starting April 1, 2024:

• Physical therapy (PT)
• Occupational therapy (OT)
• Chiropractic (Chiro)
• Home health (HH)

Beginning March 21, 2024, providers will be able to submit electronic preauthorization requests for services occurring on or after April 1, 2024.

Speech Therapy

On February 1, 2024, Highmark integrated Helion Arc into the Predictal workflow for UM of outpatient speech therapy. See the recent Special Bulletin for more information. Since April 1, 2023, prior authorization has been required for commercial plans for speech therapy (ST) in the Highmark Blue Cross Blue Shield service area.

Submitting Auth Requests Electronically – Faster Approvals

Availity^® is where you will submit electronic prior authorization requests via the Predictal™ Auth Automation Hub, which will connect you seamlessly to Helion Arc. These applications enable offices to submit, update, and query medical authorization requests. Submitting prior authorization requests electronically leads to faster approvals.

Accessing Predictal

From Availity’s main page, there are two ways to reach Predictal:

OPTION 1: Click Payer Spaces on the task bar and choose your Highmark plan. From Highmark Blue Cross Blue Shield Payer Spaces, scroll down to Applications and click the Predictal tile.

OPTION 2: Click Patient Registration from the task bar, choose Authorizations & Referrals from the drop-down menu, and then select Authorization Request. You will need to fill in the requested information before being routed to Predictal.

Authorization Checklist

The checklist below will help you and your staff prepare for the change occurring on April 1:

• Are you and your team registered with Availity?
To register, go here. For more information about the transition to Availity, see the links below:
• Provider Portal Transition
• Frequently Asked Questions

• Have you signed up for any training sessions on how to use Availity?

  To get started, log in to Availity:

  • Access the Help & Training tab on the homepage:
  • Click Get Trained from the drop-down menu to view recorded demos and webinars.

• Have you used Predictal to submit an authorization request?

  The PRC has resources on the Procedures/Service Requiring Prior Authorization page that will walk you through the electronic auth submission process.

What is Helion?

Helion is a health care technology and services company that helps payers cultivate high-performing networks while empowering providers to operate at their best — and in doing so, help patients heal better. You can learn more about Helion here.

Have you and your team signed up for one of the live training sessions offered by Highmark?

See the list of training sessions for physical medicine and home health providers mentioned above.

Have more questions?

Visit the Procedures/Service Requiring Prior Authorizationpage on the PRC.

If you need assistance regarding electronic authorization workflows, you can email us at ElecAuthSubmit@highmark.com.