Utilization management (UM) of outpatient physical medicine services — physical therapy, occupational therapy, and manipulation services — is Highmark-managed as of December 4, 2023.
The preferred — and fastest — method to submit preauthorization requests and receive approvals is the online provider portal, Availity Essentials.
Reference Materials
Instructional Videos
Click the links below to view the videos. If you experience an issue, please refresh your browser. If the issue persists, contact resourcecenter@email.highmark.com.
Availity
Authorization Requirements
For additional information and resources on submitting authorizations, CLICK HERE.
High Performing Providers
The High Performing Provider (HPP) designation is replacing the former Pathways Program effective January 1, 2025, for providers in all Highmark service areas. It is designed to give Highmark a formal process and framework for identifying and rewarding high-performing providers based on a defined set of metrics, allowing qualifying providers to have greater self-management.
For more information, read our Special Bulletin and Frequently Asked Questions.
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What is Helion?
Helion is a health care technology and services company that helps payers cultivate high-performing networks while empowering providers to operate at their best — and in doing so, help patients heal better.
You can learn more about Helion here.
Last updated on 5/31/2024 10:05:15 AM