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

Recent noteworthy changes occurred in the following sections:

  • Chapter 2, Unit 6: The BlueCard Program > 2.6 NAIC Codes > PENNSYLVANIA
  • Chapter 3, Unit 2: Professional Provider Credentialing > 3.2 Highmark Network Credentialing Policy > 24/7 AVAILABILITY REQUIREMENTS
  • Chapter 3, Unit 2: Professional Provider Credentialing > 3.2 Credentialing Requirements For Facility-Based Providers > FACILITY-BASED PRACTITIONER CREDENTIALING POLICY
  • Chapter 3, Unit 4: Organizational Provider Participation (Facility/Ancillary) > 3.4 Urgent Care Centers/Medical Aid Units > Billing Guidelines
  • Chapter 6, Unit 2: Electronic Claim Submission > 6.2 NAIC Codes > PENNSYLVANIA

For detailed descriptions of these recent changes, visit the Highmark Provider Manual Changes page.


 

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