During the year, Highmark adjusts the List of Procedures and Durable Medical Equipment (DME) Requiring Authorization. For information regarding authorizations required for a member’s specific benefit plan, providers may:
|October 20, 2022||Authorization Letters Available in NaviNet for Inpatient Services|
|November 1, 2022||Prior Authorization No Longer Needed for Glimepiride and Glyburide|
|November 7, 2022||Authorizations Section Added To Provider Resource Center|
|November 18, 2022||Enhancements to eviCore Authorization Process|
|November 23, 2022||Outpatient Services, Ancillary, DME And eviCore Authorizations Routed to New Utilization Management Tool|
|December 1, 2022||New Go-Live Date! Authorizations Required for OOA And OON Musculoskeletal, Genetic Testing, and Radiation Oncology Services|
|December 9, 2022||Echocardiogram Code to Be Removed From Prior Authorization List|
|December 31, 2022||Sunsetting: WholeHealth Living’s Rapid Response System Interactive Voice Response Option For Authorizations|
|February 2023||MCG Chosen as Utilization Management Clinical Criteria Vendor|
|January 1 and April 1, 2023||Upcoming Prior Authorization Changes|
|March 1, 2023||Two Injectables to Require Prior Authorization Beginning March 1, 2023|
To view the full List of Procedures/DME Requiring Authorization, click Requiring Authorization in the gray bar near the top of the PRC homepage.
The Highmark member must be eligible on the date of service and the service must be a covered benefit for Highmark to pay the claim.
NaviNet® is the preferred method for: