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:

  • New HTML Format – We recently transitioned the contents of the entire Highmark Provider Manual from a PDF-based platform to a web-based one. The new format makes it easier to view and search the manual, including within individual chapters and units. Read the full article about the change in the April Provider News.
  • Chapter 2, Unit 6: The BlueCard – The amount for itemizing high-dollar host claims was lowered from $250,000 to $100,000. In addition, the method for submitting those claims has changed to fax and email, rather than physical mail.
  • Chapter 3, Unit 2: Professional Provider Credentialing and Chapter 3, Unit 3: Professional Provider Guidelines – Information related to credentialing for New York providers has been updated.

 

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