WebImportant Legal Information: Highmark Blue Shield, Highmark Benefits Group, Highmark Choice Company, Highmark Senior Health Company, and/or Highmark Health Insurance … WebA. For contracted in-network providers in the national Blue Cross Blue Shield Medicare Advantage PPO network, the requesting (ordering) doctor is responsible for obtaining a prior authorization before the delivery of non-urgent services. Providers nationally would submit the prior authorization request directly to Highmark for review.

Highmark Blue Shield

WebHighmark’s Customer Service department at 1-866-731-2045, Option 2, after the approved authorization is provided by NIA and request that an adjustment be made. Overview of appeal process All existing appeal rights that currently apply to Highmark’s authorization process will apply to the NIA authorization process. Those appeal rights are WebAug 1, 2024 · Highmark’s prior authorization requirements ensure that our members receive the most appropriate care delivery in alignment with nationally accepted evidence-based guidelines. chathamkulam institute

Authorization Requirements - Highmark Blue Cross Blue Shield

WebSep 30, 2016 · Using NaviNet is the preferred way to request prior authorization/notification from NIA. If you do not yet have NaviNet, you may request authorizations/notifications by … WebThe associated preauthorization forms can be found here. Behavioral Health: 877-650-6112 Gastric Surgery/Therapy/Durable Medical Equipment/Outpatient Procedures: 888-236 … Webthroughout our service areas. Beginning November 1, 2024, claims for services on the prior authorization list received without authorization will deny and a request for medical records will be sent to the provider’s local Blue Plan. To accommodate electronic submission of authorization requests, Highmark is enabling our NaviNet ® customizable drawer dividers