Authorization Guidance
Type a procedure code or name into the search bar to find out if prior authorization is required.
Prior Authorization
Find out how to submit, update, and inquire about authorization requests.
Obtaining Authorization
Before you submit a prior authorization request, check member eligibility & benefits via Availity.
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Learn to Submit an Authorization
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Discover the key milestones in submitting an electronic authorization through interactive online learning.
Medical Policies
We maintain evidence-based coverage guidelines and monitor evolving therapies to ensure appropriate benefit adjudication, patient safety, and optimized treatment.
MCG Clinical Criteria
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Highmark incorporates MCG Health evidence-based clinical guidelines into our clinical decision support criteria.
Clinical Guidance
Find clinical guidance for certain service types from eviCore.
Care Management Programs
Highmark offers a wide range of care management programs and policies.
EDI 278
If you are unable to use Availity for your electronic authorization submissions, you may use HIPAA Health Services Review (278) electronic transactions through EDI.
Additional Resources
Inter-Plan Programs
Highmark offers members the ability to access cost-effective health care even when they're outside their plan's service area.
Authorization Status
Use the Predictal Auth Automation Hub within Highmark’s Payer Spaces in Availity. For Inpatient Planned Requests, call the appropriate Clinical Services number & press 2 for authorization requirements/status.
Forms
Find the forms you’ll need in order to fax your prior authorization request.
Additional Help
Provider Service Center
Can't find an answer? Call us: 8 a.m. to 5 p.m. EST, Monday through Friday.
Clinical Services
Still have questions? Call us: 8 a.m. to 5 p.m. EST, Monday through Friday.
