Provider Training

These trainings are a great way to give current staff helpful information about Highmark policies, programs and procedures.

Provider Resource Center

• PRC User Guide

Welcome Documentation

• Member’s Rights and Responsibilities

NaviNet Self Service

• Entering Service Locations For Specialty Rx Prior Authorization In Navinet
• NaviNet Basics
• NaviNet Tips
• Confirming Networks in NaviNet
• EFT Attestation and Registration Guide
• Physician Medicine Mgmt Program - Printable Slide Deck
• Provider File Management Guide
• Virtual Training: Authorization Process Changes for Urgent/Unplanned Inpatient Requests

Medicare Advantage and Part D - General Compliance Training and Combatting Fraud, Waste and Abuse Training

This training is a 4-step process. Please review each link in order. After Step 3, open the link for the Training Attestation.

• Step 1: Highmark Training
• Step 2: Medicare Parts C and D General Compliance Training
• Step 3: Combating Medicare Parts C and D Fraud, Waste and Abuse
• Step 4: Training Attestation
  

Informational Training and Documentation

• Calendar Year (CY) 2014-15 Office of Inspector General (OIG) Risk Adjustment Data Validation Audit Medical Record Request FAQs
• Calendar Year (CY) 2014-15 Office of Inspector General (OIG) Risk Adjustment Data Validation Audit Medical Record Request FAQs for Behavioral Health Providers
• Calendar Year (CY) 2015, 2014 DOS Contract-Level Risk Adjustment Data Validation (CON15 RADV) Medical Record Request FAQs
• Calendar Year (CY) 2018 DOS HHS Risk Adjustment Data Validation (HHS-RADV) Program FAQs
• Calendar Year (CY) 2018 DOS HHS Risk Adjustment Data Validation (HHS-RADV) Program FAQs For Behavioral Health Providers
• Home Health Authorizations
  
  • Home Health Authorization Process Change Guide
  • Home Health Authorization FAQs
  • Highmark Home Health Authorization Process Technical Tips: OASIS File Overview
  • Home Health Provider Portal User Guide
• Pharmacy Authorization Submittion Process: Frequently Asked Questions (FAQs)
• Post Acute Automated Care Management InterQual® Training
• Retrospective Chart Retrieval FAQs
• Retrospective Chart Retrieval FAQs for Behavioral Health Providers

Medicare Advantage Training and Documentation

• Billing the Initial Preventive Physical Examination (IPPE) & Annual Wellness Visits (AWVs) for Medicare Advantage Patients FAQs

Children's Health Insurance Program (CHIP) Training and Documentation

• CHIP Well-Child Visit/Lead Blood Test/Developmental Screening Requirements & Tips
• Filter Paper Lead Blood Testing Information
• American Academy of Pediatrics (AAP) Policy Document on Developmental Screenings
• “Get The Lead Out” postcard
• CHIP Gap Report Information
• CHIP PROMISe ID FAQs