Notifications for Providers

Several times annually, Highmark notifies providers of important policies and guidelines.
The following notification is for your information and reference.

See Highmark Blue Shield Office Manual for Participation Rules; Credentialing/Recredentialing Criteria and Procedures; Medical Record Criteria; and 24/7 Coverage Requirements

In-network providers should consult the Highmark Blue Shield Office Manual for information outlining the health plan’s network participation rules; credentialing/recredentialing criteria and procedures; medical record criteria; and 24/7 coverage requirements. The manual is available under the Education/Manuals link on Highmark’s online Provider Resource Center, which is accessible via NaviNet^® or under Helpful Links at highmarkbcbsde.com .

Information on these vital topics can be found in “Chapter 2: Provider Participation and Responsibilities,” in the following sub-units:

Participation rules:
Unit 1: “How to Participate in Highmark’s Networks”
Unit 5: “Specialist Basics”
Credentialing/recredentialing criteria and procedures:
Unit 2: “Network Credentialing Procedures”

Medical record criteria:
Unit 3: “Network Requirements and Procedures”
24/7 coverage requirements:
Unit 2: “Network Credentialing Procedures”