Authorization Guidance
Your guide to understanding and submitting authorization requests.
Authorization Submissions
Request coverage for medical, pharmacy, and specialty care.
Check Eligibility and Benefits
Verify member eligibility and coverage benefits before proceeding with your authorization request.
Submit Electronically
- all
After confirming eligibility, use Availity Essentials to submit your prior authorization request quickly and securely.
Pharmacy Requests
Go to CoverMyMeds (via Payer Spaces) for submission and tracking of pharmacy authorizations and specialty drug approvals.
Can’t Use Availity?
Clinical Policies and Gold Carding
Explore the policies and guidelines that help you get authorizations faster and simplify your workflow.
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Medical Policies
Our evidence-based policies ensure safe, effective, and appropriate coverage.
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MCG Clinical Guidelines
Guidelines to support fair and consistent coverage decisions.
Gold Carding Program
Recognizing excellence–smoother process for high performers.
Essential Resources
Inter-Plan Programs
We enable our members to access care outside the network.
Care Management Programs
Highmark ensures members get the right care tailored to their needs.
Authorization Forms
Find the forms you need to submit your authorization request.
Additional Guidance
Looking for more information about authorizations?
See Chapter 5, Unit 2 of the Highmark Provider Manual.
Provider Service Center
Can't find an answer? Call us: 8 a.m. to 5 p.m. ET, Monday through Friday.
Clinical Services
Still have questions? Call us: 8 a.m. to 5 p.m. ET, Monday through Friday.
