Highmark wholecare prior authorization

When considering medications from a class included on the Statewide PDL for MA beneficiaries, providers should try to utilize drugs that are designated as preferred.

Services centered around you. The services you need to keep your employees healthy. At MedExpress, we understand that accidents and illness can happen anytime. See the information below to help plan your visit to your MedExpress neighborhood medical center. Some exclusions may apply for select insurance plans. We strive to provide you with the best possible experience, including the insurance process. While we accept most major insurance, in-network status may vary by state and center.

Highmark wholecare prior authorization

Introducing a new provider resource experience that simplifies getting you the information you need, when you need it. Your feedback is appreciated as we work to complete the experience. The authorization is typically obtained by the ordering provider. Some authorization requirements vary by member contract. This information should not be relied on as authorization for health care services and is not a guarantee of payment. Benefit plans vary widely and are subject to change based on the contract effective dates. The provider is responsible for verification of member eligibility and covered benefits. Effective dates are subject to change. Highmark will provide written notice when codes are added to the list; deletions are announced via online publication. Portal : The preferred - and fastest - method to submit preauthorization requests and receive approvals is the online provider portal. The online provider portal Availity is designed to facilitate the processing of authorization requests in a timely, efficient manner. Highmark launched the Predictal Auth Automation Hub utilization management tool that allows offices to submit, update, and inquire on authorization requests. We have a number of step-by-step reference guides available to assist providers in the authorization process:. We also have resources available for Physical Medicine Management authorizations , which transitioned to Highmark managed in December Fax: If you are unable to use the online provider portal, you may also fax your authorization requests to one of the following departments.

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October 1 — March 31, 8 a. Please note that a representative may contact you to confirm receipt of information. By providing your email you will receive confirmation of your request as well as other helpful information from Highmark Wholecare. Enrollment in these plans depends on contract renewal. Highmark Wholecare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Highmark Wholecare does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Llame al TTY

As a provider, you have access to a wide variety of tools and resources designed to help you deliver better service. If you haven't already done so, follow these simple steps to get the most out of your Highmark Wholecare partnership. Join our network by completing this form. Login to the provider portal. Review and download Medicare Assured and Medicaid Policies. Check out the Provider Newsletter. Highmark Wholecare participating providers have access to our Provider Authorization Portal. Simply access the portal by clicking here. The new Authorization Portal was integrated into the Highmark Wholecare platform that includes all of the functionality of the original and also includes features such as:.

Highmark wholecare prior authorization

Starting January 1, , Highmark Wholecare will no longer require prior authorization for over services. A listing of the affected Medicare and Medicaid services can be found on our website here. We value your continued partnership and hope this update will help add administrative efficiencies. If you have any questions, please reach out to your Provider Account Liaison. 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.

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Some authorization requirements vary by member contract. The department maintains a list of drugs that are subject to quantity limits or daily dose limits for beneficiaries in the FFS delivery system. Back to Table of Contents. Medical Policies. This is not a valid zip code Required. Your Personal Data will be disclosed to appropriate personnel for purposes of performing services to, or on behalf of, our enterprise customers and prospective customers as part of and in relation to matters regarding our provider, health plan, and subsidiary enterprise care delivery, administration and operations. Your Personal Data will remain on file for: any period required by applicable law; and, to the extent necessary for any purpose s provided directly or indirectly herein or as may be reasonably inferred from the content contained in this notice or the website, but no longer than permitted by applicable law. To verify that your insurance is in-network, please check the listing below. Authorization Workflows. MedExpress Insurance Section. Employer Services. Authorization Status. Some exclusions may apply for select insurance plans. You also explicitly consent to the automated decision making by us, which may include the processing of your health data, to the extent that it is necessary to process your health claim swiftly and efficiently. Questions about authorization workflows.

Introducing a new provider resource experience that simplifies getting you the information you need, when you need it. Your feedback is appreciated as we work to complete the experience. The authorization is typically obtained by the ordering provider.

My 6 Digit Code xxxxxx Search. Page Content. Pharmacy Policy Search. Please search for a new location. Please enable scripts and reload this page. This information should not be relied on as authorization for health care services and is not a guarantee of payment. Check nearest location: Find the center. Authorization number not appearing, unable to locate member, questions about clinical criteria screen. By providing your email you will receive confirmation of your request as well as other helpful information from Highmark Wholecare. An Official Pennsylvania Government Website. Department of Human Services.