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Highmark community blue medicare providers

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Highmark recently launched a utilization management tool, Predictal, that allows offices to submit, update, and inquire on medical inpatient authorization requests. Fax: If you are unable to use NaviNet, you may also fax your authorization requests to one of the following departments.

The associated preauthorization forms can be found here. Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number , which can be found here. Highmark contracts with WholeHealth Networks, Inc. Additional information about the programs and links to prior authorization codes are available under Care Management Programs in the left website menu.

Authorization number not appearing, unable to locate member, questions about clinical criteria screen. 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. Medical Policy Medical Policy. Medical Policies. Medicare Advantage Medical Policies.

Requiring Authorization. Pharmacy Policy Search. Message Center. Manuals Highmark Provider Manual. Authorization Requirements. Over the course of a year, coverage for the Part A deductible could add up to significant savings. If you purchase Plan B, your Medigap coverage will pay for:. One of the most comprehensive Medigap plans is Plan C. But as of January 1, , new Medicare enrollees can no longer enroll in this plan. You may still be able to enroll in Plan C if you were eligible for Medicare before , though, and keep it if you had the plan in place already.

Plan C covers:. One option with moderate coverage is Medigap Plan D. The premium pays for these benefits:. The Medicare supplement plan that covers the most benefits is Medigap Plan F. However, like Plan C, this option is no longer available as of January 1, For those who are eligible, high-deductible Plan F is an alternative option that costs much less than its standard counterpart.

Compare the costs between regular Plan F and the high-deductible version to see if paying that deductible might be worth the savings in your monthly premium. Plan F covers:. Medigap Plan G is the most comprehensive plan outside of Plan F. Plan G covers:. The following benefits are included in Plan N:.

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Jan 12, Highmark Blue Shield plans to offer customers located in Southeastern Pennsylvania a full suite of health insurance products and solutions including Medicare Advantage, Medicaid dual eligible, Individual Affordable Care Act, Small Group Affordable Care Act, Large Group Fully Insured, Large Group Self-Insured across and , subject to. Ad% Covered By Medicare. Same As Government Tests, But Better Support. Call Us Toll-Free. Order your free home test kits. % covered by Medicare with free delivery. Dec 14, Highmark requires authorization of certain services, procedures, and/or Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) prior to performing the procedure or service. The authorization is typically obtained by the ordering provider. Some authorization requirements vary by member contract.