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Highmark Provider Manual Archive

This section contains the most recently retired document for each unit of the Highmark Provider Manual. Although the information below is not current, the archived unit may be of importance to health care providers, members, and others for historical purposes. Information in the archive will be updated when the current, corresponding unit is retired and considered obsolete for present day use.

If you have any questions or comments about the Highmark Provider Manual Archive, please contact the HPMEditor.

Date Posted
Unit
Unit Title
12/6/2018
1.2

Online Resources & Contact Information

2/5/2020
1.4

Highmark Member Information

12/11/2018
1.5

Member Rights & Responsibilities

6/22/2018
2.2

Medicare Advantage Products & Programs

7/30/2020
2.3

Other Government Programs

12/17/2018
2.4

Benefit Plan Programs

7/20/2020
2.5

Telemedicine Services

10/29/2020
2.6

The BlueCard Program

3/4/2019
3.1

Network Participation Overview

5/14/2020
3.2

Professional Provider Credentialing

5/25/2018
3.3

Professional Provider Guidelines

11/5/2019
3.4

Organizational Provider Participation (Facility/Ancillary)

7/7/2020
4.1

PCPs & Specialists

2/28/2020
4.2

Behavioral Health Providers

10/29/2020
4.3

Facility-Specific Guidelines

10/26/2018
4.4

Ancillary Services

9/30/2019
4.5

Outpatient Radiology & Laboratory

2/28/2020
4.6

Prescription Drug Programs

7/7/2020
4.7

Medical Records Documentation Requirements

7/7/2020
5.1

Care Management Overview

10/29/2020
5.2

Authorizations

7/30/2020
5.3

Medicare Advantage Procedures

3/29/2019
5.4

Behavioral Health

5/14/2020
5.5

Denials, Grievances & Appeals

7/7/2020
5.6

Quality Management

3/1/2019
5.7

Value-Based Reimbursement Programs

7/30/2020
6.1

General Claim Submission Guidelines

9/21/2018
6.2

Electronic Claim Submission

2/28/2020
6.3

Facility (UB-04/837I) Billing

10/29/2020
6.4

Professional (1500/837P) Reporting Tips

5/25/2018
6.5

1500 Claim Form Guidelines

8/21/2019
6.6

Coordination of Benefits

2/28/2020
6.7

Payment/EOBs/Remittances

12/4/2019
6.8

Payment Review

 

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Legal Information

The following entities, which serve the noted regions, are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield. West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Health Insurance Company or Highmark Senior Solutions Company. Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield. Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield.

All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration and/or to one or more of its affiliated Blue companies.