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 2: Online Resources & Contact Information
- Chapter 2, Unit 2: Medicare Advantage Products & Programs
- Chapter 3, Unit 2: Professional Provider Credentialing
- Chapter 4, Unit 2: Behavioral Health Providers
- Chapter 5, Unit 4: Behavioral Health
- Chapter 5, Unit 5: Denials, Adverse Benefit Determinations, Grievances, and Appeals
- Chapter 6, Unit 3: Facility (UB-04/8371) Billing
- Chapter 6, Unit 4: Professional (1500/837P) Reporting Tips
Relinquishment of Washington County, Ohio
Highmark Blue Cross Blue Shield in West Virginia relinquished the Washington County, Ohio, service area. The change — which was requested by Highmark — was approved by the Blue Cross Blue Shield Association (BCBSA) in November 2023.
For this reason, references to Washington County, Ohio, were removed from the following areas of the manual:
- 1.1 About Highmark
- 1.2 Highmark Websites (PUBLIC WEBSITES section)
- 2.1 Introduction (HIGHMARK’S CORPORATE ENTITIES section)
- 3.1 Directing Care to Network Providers (LOCATING NETWORK PROVIDERS section)
To see the full list of recent changes, visit the Highmark Provider Manual Changes page.
Provider News, Issue 7, July 2024 | © 2024 Highmark Blue Cross Blue Shield