Highmark Delaware's medical policy guidelines address both clinical and claim payment reimbursement issues. These guidelines address hundreds of medical issues, including diagnostic and therapeutic procedures, injectable drugs, and durable medical equipment. Some policies address procedures and services that are considered to be part of another procedure or service and, as such, are not separately payable. Many of these clinical and reimbursement guidelines are automated in our claims processing system.
You may search for topics by Keyword, Procedure Code or Policy Bulletin Number.
Medical policy guidelines for all of Highmark Delaware's medical-surgical products, including managed care.
Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. They are intended to reflect Highmark's reimbursement and coverage guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract.
Highmark retains the right to review and update the medical policy guidelines in its sole discretion. These guidelines are the proprietary information of Highmark. Any sale, copying, or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.