Highmark wholecare prior authorization

When considering medications from a class included on the Statewide PDL for MA beneficiaries, providers should try to utilize drugs that are designated as preferred.

This information will be used for purposes of performing services to, or on behalf of, our enterprise customers and prospective customers as part of and in relation to matters regarding our provider, health plan, and subsidiary enterprise care delivery, administration and operations. Your email address and phone number may be used to contact you. All reasonably appropriate measures will be taken to prevent disclosure of your Personal Data beyond the scope provided directly or indirectly herein or as may be reasonably inferred from the content contained in this notice or the website. Your Personal Data will be disclosed to appropriate personnel for purposes of performing services to, or on behalf of, our enterprise customers and prospective customers as part of and in relation to matters regarding our provider, health plan, and subsidiary enterprise care delivery, administration and operations. Notwithstanding the above disclosures, we will disclose the Personal Data we collect from you under the following circumstances:.

Highmark wholecare prior authorization

Introducing a new provider resource experience that simplifies getting you the information you need, when you need it. Your feedback is appreciated as we work to complete the experience. The authorization is typically obtained by the ordering provider. Some authorization requirements vary by member contract. This information should not be relied on as authorization for health care services and is not a guarantee of payment. 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. Portal : The preferred - and fastest - method to submit preauthorization requests and receive approvals is the online provider portal. The online provider portal Availity is designed to facilitate the processing of authorization requests in a timely, efficient manner. Highmark launched the Predictal Auth Automation Hub utilization management tool that allows offices to submit, update, and inquire on authorization requests. We have a number of step-by-step reference guides available to assist providers in the authorization process:.

The Statewide PDL is not the same as the formularies that are commonly used by commercial insurers. MedExpress Insurance Section. Additional information regarding quantity limits highmark wholecare prior authorization beneficiaries who receive their pharmacy benefits from one of the HealthChoices or Community HealthChoices MCOs is available directly from each MCO.

Services centered around you. The services you need to keep your employees healthy. At MedExpress, we understand that accidents and illness can happen anytime. See the information below to help plan your visit to your MedExpress neighborhood medical center. Some exclusions may apply for select insurance plans.

Starting January 1, , Highmark Wholecare will no longer require prior authorization for over services. A listing of the affected Medicare and Medicaid services can be found on our website here. We value your continued partnership and hope this update will help add administrative efficiencies. If you have any questions, please reach out to your Provider Account Liaison. 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. You're being redirected to the CMS search site. Quick Links: Manuals.

Highmark wholecare prior authorization

As a provider, you have access to a wide variety of tools and resources designed to help you deliver better service. If you haven't already done so, follow these simple steps to get the most out of your Highmark Wholecare partnership. Join our network by completing this form. Login to the provider portal. Review and download Medicare Assured and Medicaid Policies. Check out the Provider Newsletter. Highmark Wholecare participating providers have access to our Provider Authorization Portal. Simply access the portal by clicking here.

Fifa access code

Powered by Insightin Health. For additional information regarding your specific plan and coverage, please contact your insurance provider directly. You can see a licensed MedExpress medical professional from the comfort of your home with secure video conferencing. All drugs designated as non-preferred on the Statewide PDL require prior authorization through the beneficiary's pharmacy benefits provider. Services centered around you. Provider Directory. Your feedback is appreciated as we work to complete the experience. Site Map Legal Information. Notwithstanding the above disclosures, we will disclose the Personal Data we collect from you under the following circumstances:. The online provider portal Availity is designed to facilitate the processing of authorization requests in a timely, efficient manner.

Introducing a new provider resource experience that simplifies getting you the information you need, when you need it. Your feedback is appreciated as we work to complete the experience.

An Official Pennsylvania Government Website. Main Menu. For additional information regarding your specific plan and coverage, please contact your insurance provider directly. Get your free kit! The associated preauthorization forms can be found here. Portal : The preferred - and fastest - method to submit preauthorization requests and receive approvals is the online provider portal. Services and Treatment. The committee's recommendations are based on the clinical effectiveness, safety, outcomes, and unique indications of all drugs included in each PDL class. Better Health Workplace Wellness. Drugs designated as non-preferred on the Statewide PDL remain available to MA beneficiaries when determined to be medically necessary through the prior authorization process. Contact Us Provider Directory. The Statewide PDL is therapeutically based. MedExpress Color Block Tab. Back to Table of Contents. Manuals Highmark Provider Manual.