Highmark Provider Manual

[{"id":4540,"versionId":16626,"chapterNumber":1,"title":"General Information","visible":true,"topics":[{"id":6727,"chapterId":4540,"unitNumber":1,"timestamp":"10/28/2021","title":"Introduction","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter1-unit1.pdf","visible":true,"liveStatus":2},{"id":6728,"chapterId":4540,"unitNumber":2,"timestamp":"2/1/2023","title":"Online Resources \u0026 Contact Information","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter1-unit2.pdf","visible":true,"liveStatus":2},{"id":6729,"chapterId":4540,"unitNumber":3,"timestamp":"6/30/2022","title":"Electronic Solutions – EDI \u0026 NaviNet","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter1-unit3.pdf","visible":false,"liveStatus":2},{"id":6730,"chapterId":4540,"unitNumber":4,"timestamp":"7/29/2022","title":"Highmark Member Information","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter1-unit4.pdf","visible":false,"liveStatus":2},{"id":6731,"chapterId":4540,"unitNumber":5,"timestamp":"12/30/2022","title":"Member Rights \u0026 Responsibilities","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter1-unit5.pdf","visible":false,"liveStatus":2}],"liveStatus":2},{"id":4541,"versionId":16626,"chapterNumber":2,"title":"Product Information","visible":true,"topics":[{"id":6732,"chapterId":4541,"unitNumber":1,"timestamp":"12/30/2022","title":"Product Overview","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter2-unit1.pdf","visible":true,"liveStatus":2},{"id":6733,"chapterId":4541,"unitNumber":2,"timestamp":"12/30/2022","title":"Medicare Advantage Products \u0026 Programs","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter2-unit2.pdf","visible":true,"liveStatus":2},{"id":6734,"chapterId":4541,"unitNumber":3,"timestamp":"3/24/2023","title":"Other Government Programs","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter2-unit3.pdf","visible":true,"liveStatus":2},{"id":6735,"chapterId":4541,"unitNumber":4,"timestamp":"11/30/2021","title":"Benefit Plan Programs","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter2-unit4.pdf","visible":true,"liveStatus":2},{"id":6736,"chapterId":4541,"unitNumber":5,"timestamp":"12/30/2022","title":"Telemedicine Services","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter2-unit5.pdf","visible":true,"liveStatus":2},{"id":6737,"chapterId":4541,"unitNumber":6,"timestamp":"11/30/2021","title":"The BlueCard Program","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter2-unit6.pdf","visible":true,"liveStatus":2}],"liveStatus":2},{"id":4542,"versionId":16626,"chapterNumber":3,"title":"Provider Network Participation","visible":true,"topics":[{"id":6738,"chapterId":4542,"unitNumber":1,"timestamp":"8/31/2022","title":"Network Participation Overview","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter3-unit1.pdf","visible":true,"liveStatus":2},{"id":6739,"chapterId":4542,"unitNumber":2,"timestamp":"3/24/2023","title":"Professional Provider Credentialing","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter3-unit2.pdf","visible":true,"liveStatus":2},{"id":6740,"chapterId":4542,"unitNumber":3,"timestamp":"7/29/2022","title":"Professional Provider Guidelines","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter3-unit3.pdf","visible":true,"liveStatus":2},{"id":6741,"chapterId":4542,"unitNumber":4,"timestamp":"12/6/2022","title":"Organizational Provider Participation (Facility /Ancillary)","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter3-unit4.pdf","visible":true,"liveStatus":2},{"id":6742,"chapterId":4542,"unitNumber":5,"timestamp":"10/28/2021","title":"Ohio Healthcare Simplification Act","description":"\u003ch6\u003e\u003cspan\u003e(The information in this\u0026nbsp;\u003c/span\u003e\u003cspan\u003eunit\u0026nbsp;\u003c/span\u003e\u003cspan\u003eis\u0026nbsp;\u003c/span\u003e\u003cspan\u003eapplicable to\u0026nbsp;\u003c/span\u003e\u003cspan\u003ePA/WV providers only).\u003c/span\u003e\u003c/h6\u003e","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter3-unit5.pdf","visible":true,"liveStatus":2}],"liveStatus":2},{"id":4543,"versionId":16626,"chapterNumber":4,"title":"Provider Responsibilities \u0026 Guidelines","visible":true,"topics":[{"id":6743,"chapterId":4543,"unitNumber":1,"timestamp":"2/1/2023","title":"PCPs \u0026 Specialists","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter4-unit1.pdf","visible":true,"liveStatus":2},{"id":6744,"chapterId":4543,"unitNumber":2,"timestamp":"12/30/2022","title":"Behavioral Health Providers","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter4-unit2.pdf","visible":true,"liveStatus":2},{"id":6745,"chapterId":4543,"unitNumber":3,"timestamp":"2/13/2023","title":"Facility-Specific Guidelines","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter4-unit3.pdf","visible":true,"liveStatus":2},{"id":6746,"chapterId":4543,"unitNumber":4,"timestamp":"3/24/2023","title":"Ancillary Services","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter4-unit4.pdf","visible":true,"liveStatus":2},{"id":6747,"chapterId":4543,"unitNumber":5,"timestamp":"1/6/2023","title":"Outpatient Radiology \u0026 Laboratory","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter4-unit5.pdf","visible":true,"liveStatus":2},{"id":6748,"chapterId":4543,"unitNumber":6,"timestamp":"12/30/2022","title":"Prescription Drug Programs","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter4-unit6.pdf","visible":false,"liveStatus":2},{"id":6749,"chapterId":4543,"unitNumber":7,"timestamp":"6/30/2022","title":"Medical Records Documentation Requirements","description":"","filename":"https://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter4-unit7.pdf","visible":false,"liveStatus":2}],"liveStatus":2},{"id":4544,"versionId":16626,"chapterNumber":5,"title":"Care \u0026 Quality Management","visible":true,"topics":[{"id":6750,"chapterId":4544,"unitNumber":1,"timestamp":"3/24/2023","title":"Care Management Overview","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter5-unit1.pdf","visible":true,"liveStatus":2},{"id":6751,"chapterId":4544,"unitNumber":2,"timestamp":"3/24/2023","title":"Authorizations","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter5-unit2.pdf","visible":true,"liveStatus":2},{"id":6752,"chapterId":4544,"unitNumber":3,"timestamp":"3/24/2023","title":"Medicare Advantage Procedures","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter5-unit3.pdf","visible":true,"liveStatus":2},{"id":6753,"chapterId":4544,"unitNumber":4,"timestamp":"2/13/2023","title":"Behavioral Health","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter5-unit4.pdf","visible":false,"liveStatus":2},{"id":6754,"chapterId":4544,"unitNumber":5,"timestamp":"12/30/2022","title":"Denials, Grievances \u0026 Appeals","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter5-unit5.pdf","visible":false,"liveStatus":2},{"id":6755,"chapterId":4544,"unitNumber":6,"timestamp":"12/30/2022","title":"Quality Management","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter5-unit6.pdf","visible":false,"liveStatus":2},{"id":6756,"chapterId":4544,"unitNumber":7,"timestamp":"12/30/2021","title":"Value-Based Reimbursement Programs","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter5-unit7.pdf","visible":false,"liveStatus":2}],"liveStatus":2},{"id":4545,"versionId":16626,"chapterNumber":6,"title":"Billing \u0026 Payment","visible":true,"topics":[{"id":6757,"chapterId":4545,"unitNumber":1,"timestamp":"11/30/2021","title":"General Claim Submission Guidelines","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter6-unit1.pdf","visible":true,"liveStatus":2},{"id":6758,"chapterId":4545,"unitNumber":2,"timestamp":"3/24/2023","title":"Electronic Claim Submission","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter6-unit2.pdf","visible":true,"liveStatus":2},{"id":6759,"chapterId":4545,"unitNumber":3,"timestamp":"2/13/2023","title":"Facility (UB-04/837I) Billing","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter6-unit3.pdf","visible":true,"liveStatus":2},{"id":6760,"chapterId":4545,"unitNumber":4,"timestamp":"2/13/2023","title":"Professional (1500/837P) Reporting Tips","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter6-unit4.pdf","visible":true,"liveStatus":2},{"id":6761,"chapterId":4545,"unitNumber":5,"timestamp":"10/28/2021","title":"1500 Claim Form Guidelines","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter6-unit5.pdf","visible":false,"liveStatus":2},{"id":6762,"chapterId":4545,"unitNumber":6,"timestamp":"10/28/2021","title":"Coordination of Benefits","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter6-unit6.pdf","visible":false,"liveStatus":2},{"id":6763,"chapterId":4545,"unitNumber":7,"timestamp":"6/30/2022","title":"Payment/EOBs/Remittances","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter6-unit7.pdf","visible":false,"liveStatus":2},{"id":6764,"chapterId":4545,"unitNumber":8,"timestamp":"10/5/2022","title":"Payment Review","description":"","filename":"http://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter6-unit8.pdf","visible":false,"liveStatus":2}],"liveStatus":2}]

Quick Reference

{{chapter.chapterNumber}}

{{chapter.title}}

Unit {{topic.unitNumber}}: {{topic.title}}

{{fm.formatLastRevisedDate(topic.timestamp)}}

View More View Less

{{chapter.chapterNumber}} {{chapter.title}}

Unit {{topic.unitNumber}}: {{topic.title}}

{{fm.formatLastRevisedDate(topic.timestamp)}}

Report Site Issues

Provider Directory

Legal Information

Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration.