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AIM Specialty Health. BlueCard Program. Braven Health. Braven Health Supportive Care Program. Case Management. Chronic Care Program. Horizon Behavioral Health. Horizon Care Home. Horizon Supportive Care Program. Medical Injectables Program. Our Pledge. Patient Health Support. Pharmacy Programs. Recognition Programs and Partnerships. Risk Adjustment Overview. Self Service. Surgical and Implantable Device Management Program.

Value-Based Programs. Demographic Updates. Utilization Management. Clinical Practice Guidelines. Cultural Competency. Provider Directory. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania.

Quick Links: Manuals. Highmark Provider Manual. Medical Policy Medical Policy. Medical Policies. Medicare Advantage Medical Policies. Requiring Authorization. Pharmacy Policy Search. Message Center.

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Highmark blue shield service codes	Quality Resource Center. Pharmacy Programs. Message Center. Surgical and Implantable Device Management Program. Quick Links: Manuals.

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Highmark is a nationally recognized industry leader in developing and implementing up-to-date, medically sound policy guidelines. There are many policy guidelines addressing medical technology, therapeutic procedures, medical equipment and supplies, and behavioral health. They are used to administer all Highmark medical-surgical products and various fee schedule products.

In addition to commercial products, we also maintain medical policy coverage guidelines for our Medicare Advantage products. Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. They are intended to reflect Highmark's reimbursement and coverage guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract, and subject to the applicable laws of your state. Highmark retains the right to review and update its medical policy guidelines at its sole discretion.

These guidelines are the proprietary information of Highmark. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use. Contact Us. Provider Directory. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania.

Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Quick Links: Manuals. Highmark Provider Manual. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Quick Links: Manuals.

Highmark Provider Manual. Medical Policy Medical Policy. Medical Policies. Medicare Advantage Medical Policies. Requiring Authorization. Pharmacy Policy Search. Message Center. Manuals Highmark Provider Manual. Authorization Requirements. Inpatient admissions e. Inpatient Authorization Guide : Click here for the Predictal step-by-step inpatient authorizations reference guide.

Outpatient Authorization Guide : Click here for the Predictal step-by-step outpatient authorizations reference guide. Questions about authorization workflows.

Check status of submitted authorizations. Site Map Legal Information. NaviNet Portal. Authorization Workflows. Authorization Status.

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