Highmark recently rolled out a new utilization management tool (UM) for the submission of authorization requests. Effective January 9, 2023, authorization requests for Behavioral Health (BH) services also are being routed to the new clinical platform. To learn more, click here .
Effective February 13, 2023, access to the Medicare Advantage (MA) Medical Policy search site will be removed from the Provider Resource Center (PRC) – and the search site will be taken down.
Providers should use the Centers for Medicare and Medicaid Services Medicare Coverage Database website to search National Coverage Determinations, Local Coverage Determinations, and Local Coverage Articles. To learn more, go here .
Effective April 1, 2023, Highmark will begin publishing its standard professional fee schedules on a quarterly basis. This change will enable us to align fee schedule updates with our quarterly code updates. For more information, go here .