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Care Management Programs

• Advanced Imaging and Cardiology Services Program
• AIS Home Visit Program
• Care Management Programs
• DIP Levels
• Laboratory Management Program
• Musculoskeletal Surgery and Interventional Pain Management Services Prior Auth Program
• Oncology Pathways Program
• Physical Medicine Management Program
• Post-Acute Care Management for Medicare Advantage Members
• Prior Authorization/Notification Information - Radiology Management Program
• Privileging Appeal Process - PA
• Privileging Application and Requirements - Radiology Management - PA
• Radiation Therapy Authorization Program
• Radiology Management Program

Claims, Payment & Reimbursement

• Ambulance Treat No Transport FAQs
• APC Pricing Component Update Calendar
• Billing Highlights
• Documentation Guidelines for Evaluation and Management Services
• Electronic Data Interchange (EDI) Services
• Fee Schedule Information
• Guidelines for HUD/HUE
• Highmark Coding Tips
• Highmark Medical Policy
• Hospital Outpatient Prospective Payment System (OPPS) Based Payment Method
• How are Medical Policies Developed? - PA
• Information Regarding Significant Edits
• List of Procedure Codes Requiring NDC Information
• Medical Policy
• Medical Policy Department
• Medical Policy Frequently Asked Questions (FAQs)
• Medical Policy Update Newsletter
• Medically Unlikely Edit Update Schedule
• Medicare Advantage Medical Policy
• Medicare Advantage Medical Policy Frequently Asked Questions (FAQs)
• Oncology Management Program Fee Schedule
• Procedures/Service Requiring Prior Authorization
• Reimbursement Policy
• Reimbursement Policy Archive

COVID-19

• COVID-19 (Coronavirus) Information
• Billing/Coverage for COVID-19
• Billing/Coverage for COVID-19
• Clinical/Operational Updates
• Talking to Your Patients
• Telemedicine Webinar
• Telemedicine and Virtual Visits

Credentialing

• Organizational Initial Credentialing Set Up
• Organizational Behavioral Health Initial Credentialing Set Up
• Organizational Credentialing Forms
• Professional Initial Credentialing Set Up
• Initial Credentialing Request Form

Education/Manuals

• A Key Area of Focus to Combat Childhood & Adult Obesity
• Advance Care Planning - PA
• Article VIII of the Bylaws of Highmark Inc. and Highmark Blue Shield Review Committee Guidelines
• axialHealthcare Substance Use Risk and Recovery Programs
• Behavioral Health ACM Authorization Submission Manual
• Behavioral Health Practice Resources
• Behavioral Health Toolkit for Primary Care Physicians
• CAHPS®/QHP EES Survey Results
• Childhood Obesity Physician Tool Kit
• Chlamydia Testing in Young Women: Room for Improvement
• Clinical Programs and Services for Highmark Members
• Coding Education/HCC University
• Educational Resources - Member and Provider
• Free cultural competency training
• Health Care Disparities: An Overview
• Health Equity & Quality Services
• Health Literacy: A Closer Look
• HEDIS
• HEDIS Provider Information Document
• HEDIS Results - HBCBS
• Highmark Provider Glossary
• Highmark Provider Manual
• Highmark Provider Manual Appendix - PA
• Highmark Provider Manual Archive
• Highmark Provider Manual Tip Sheet Index
• Improving Blood Pressure Control
• Inventory Request Form
• Inventory Request Form
• Medicare Advantage Member Evidence of Coverage Booklets
• Medicare Advantage Supplemental Requirements
• Office Site and Medical Record Evaluation Forms
• Optimizing Treatment In The Patient With Rheumatoid Arthritis
• PCP and OBGYN Practice Resources
• Population Health University
• Practice Site Resources
• Preventive Health Guidelines
• Provider Data Accuracy Compliance
• Provider File Management: NaviNet Guide
• Risk Adjustment Programs
• SilverSneakers
• What is Culturally Competent Health Care

Forms

• Behavioral Health Forms
• Certificate of Medical Necessity (CMN) for DME Providers
• FEP Medical Health Forms
• Medical Injectable Drugs
• Miscellaneous Forms
• Pharmacy Prior Authorization Forms
• Provider Information Management Forms

High Performance Networks

• High Performance Home Health Network
• High Performance Physical Therapy and Chiropractic Networks
• High Performance SNF Network
• Select DME Network

Inter-Plan Programs

• Blue Distinction Centers For Specialty Care Program
• BlueCard Information Center
• Electronic Provider Access (EPA) for Pre-Service Review
• Medical Policy and Pre-certification Pre-authorization Information for Out-of-Area Members
• Medicare Advantage PFFS Search

Newsletters/Notices

• COVID-19 (Coronavirus) Information for Providers
• e-Subscribe for Publications and Notifications
• Facility Bulletins
• Helion Bulletin
• Hot Topic Library
• Hot Topic Library - 2014
• Hot Topic Library - 2015
• Hot Topic Library - 2016
• Hot Topic Library 2013
• Medical Policy Update Newsletter
• Plan Central Library
• Plan Central Library - 2013
• Plan Central Library - 2014
• Plan Central Library - 2015
• Plan Central Library - 2016
• Plan Central Library - 2017
• Plan Central Library - 2018
• Plan Central Library - 2019
• Plan Central Library - 2020
• Provider News
• Special Bulletins & Mailings

Pharmacy Program/Formularies

• About ID cards - Information for Pharmacists PA & WV
• Drug Utilization Review PA
• Formulary Information
• Hemophilia and Bleeding Disorder Drug Program
• List of Procedure Codes Requiring NDC Information
• Managed Prescription Drug Coverage (MRxC)
• Medical Injectable Drug Program - HBCBS
• Medicare Formularies
• Medicare Part B Drug Website
• Medicare Part D Hospice Prior Authorization Information - HBCBS
• Pharmaceutical Management (Clinical Management Programs)
• Pharmacy Benefits Program HBCBS
• Pharmacy Information
• Pharmacy Policies - SEARCH
• Prescription Drug Prior Authorization - PA
• Process for Requesting Drug Coverage from a Pharmaceutical Management Program HBS
• Program for Self-Administered Injectable or Oral Biotechnology Drugs
• What is the Formulary?

Product Information

• Product Information

Provider Training

• Provider Orientation
• Provider Training

Value-Based Reimbursement Programs

• 2016 Medicare Advantage Stars Primary Care Incentive Program
• 2016 Medication Reconciliation Post Discharge-Gap Closure Incentive Program
• 2018 Medicare Advantage Stars Primary Care Incentive Program
• 2019 Medicare Advantage Stars Primary Care Incentive Program
• 2020 Medicare Advantage Stars Primary Care Incentive Program
• 2021 Medicare Advantage Stars Primary Care Incentive Program
• Annual Wellness and Initial Preventive Physical Exam Rate
• Breast-Cancer-Screening
• Colorectal Cancer Screening
• Comprehensive Diabetes Care: Eye Exam (retinal) Performed
• Comprehensive Diabetes Care: HbA1c Control (<=9%)
• Comprehensive Diabetes Care: Medical Attention for Nephropathy
• Controlling High Blood Pressure
• Fall Risk Assessment - MA Stars
• Follow-up After Emergency Department Visit for Patients with Multiple Chronic Conditions
• Improving Bladder Control
• Inter-Plan Medicare Advantage Care Management and Provider Engagement Program
• MA Stars - Member Rewards
• Medicare Advantage Member and Provider Programs (PA)
• Medicare Advantage Stars
• Medicare Advantage Stars About - PA WV NaviNet
• Medication Adherence for Cholesterol (Statins)
• Medication Adherence for Diabetes Medication
• Medication Adherence for Hypertension (RASA)
• Medication Therapy Management
• Monitoring Physical Activity
• Osteoporosis Management in Women who had a Fracture
• Patient Engagement After Inpatient Discharge
• Plan All-Cause Readmissions: Medicare Advantage
• Provider Templates for Mailing to Patients
• Quality Blue Hospital Program
• Skilled Nursing Facility Pay-For-Value Program
• Specialist Performance Initiative
• Statin Therapy For Patients With Cardiovascular Disease
• Statin Use in Persons with Diabetes
• TRC (Transitions of Care) Medication Reconciliation Post-Discharge
• True Performance Lite Program
• Value Based Programs
• Vendor Partner: AdhereHealth
• Vendor Partner: Home Access
• Vendor Partner: Matrix

Other Resources

• 2018 ACA Select Network
• Highmark 2017
• Highmark 2018: Important Product News
• Highmark PRC Home
• Legal Information
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• Provider Consent Decree FAQs
• Provider FAQ
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• Site Map