Staying Up to Date With the Highmark Provider Manual
Ensure you are regularly reviewing the Highmark Provider Manual for our most recent guidance on:
- Participation Rules
- Credentialing/Recredentialing Criteria and Procedures
- Medical Record Criteria
- Requirements for 24/7 Coverage
Some recent noteworthy changes include:
- Chapter 2 Unit 3 – Other Government Programs:
- Information on CHIP eligibility has been updated to reflect all eligibility forms and questions should be directed to the Department of Human Services instead of Highmark.
- Chapter 3 Unit 2 – Professional Provider Credentialing:
- Information on sanctions has been added throughout this unit.
- The facility-based practitioner credentialing policy has been updated.
- Chapter 4 Unit 4 – Ancillary Services, Chapter 5 Unit 1 – Care Management Overview, Chapter 5 Unit 2 - Authorizations, Chapter 5 Unit 3 – Medicare Advantage Procedures:
- References to Tivity or WholeHealth Network have been replaced by the company’s new name, WholeHealth Living.
- Chapter 6 Unit 2 – Electronic Claim Submission:
- The NY address and fax number have been added to Electronic Claim Attachments.
- The New York NAIC Codes/Plan Codes have been updated.
Provider News, Issue 3, March 2023 | © 2023 Highmark Blue Cross Blue Shield Delaware