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Carefirst bluechoice pre certification

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Benefit plans vary widely and are subject to change based on the contract effective dates. The provider is responsible for verification of member eligibility and covered benefits. Effective dates are subject to change. Highmark will provide written notice when codes are added to the list; deletions are announced via online publication.

Examples of services that may require authorization include the following. This is not an all-inclusive list. Benefits can vary; always confirm member coverage. The online portal is designed to facilitate the processing of authorization requests in a timely, efficient manner.

If you are a Highmark network provider and have not signed up for NaviNet, learn how to do so here. 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. ID cards specify Individual Plan.

Sign in. View the FEP-specific code list and forms. Prior authorization contacts vary for Shared Administration groups. View the Shared Administration contact list for details. Current location: AK Washington and other states. Submitting Prior Authorization Prior authorization submission websites Prior authorization requests are submitted on different websites for Individual and non-Individual plan members groups, associations, etc.

Non-individual members Use Availity to submit prior authorizations and check codes.

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Apply Now. Interested in making a meaningful difference in our community? Explore our career opportunities to find your place with one of the world's most ethical companies. Search Jobs. Have a question for us? If you are looking to buy or renew a CareFirst plan, please contact us at Have a question about individual or family plans? Visit our contact us page. Skip Navigation. Login Register. Explore our Insurance Basics pages. Need Insurance? Log In or Register. Find a Doctor. Shop Insurance Plans.

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Learn about who we are and who we advocate for. Discover how we're investing in the health of our communities. Learn how we're working to transform healthcare. Our online resources, tools and support make doing business with CareFirst easy, so you can focus on patient care. Apply Now. Interested in making a meaningful difference in our community? Explore our career opportunities to find your place with one of the world's most ethical companies.

Search Jobs. Have a question for us? If you are looking to buy or renew a CareFirst plan, please contact us at Have a question about individual or family plans? Visit our contact us page. Skip Navigation. Login Register. Explore our Insurance Basics pages. Need Insurance?