Case Management Referrals: Caring for Members with Complex Conditions

Highmark encourages providers to identify members who could benefit from coordinated case management services. Referrals to our Clinical Care and Wellness programs are quick and easy, using Availity Essentials.

This feature enables providers to connect Highmark members who have chronic conditions and complex medical needs to the right clinical support.

To access this feature:

• Log into Availity.
• Click Payer Spaces on the task bar and choose your Highmark plan.
• From Payer Spaces, scroll down to Applications and click Predictal – Existing Authorizations Only.
• From the Predictal™ Auth Automation Hub, hover over the left navigational panel and select Case Management Referral.
• Acknowledge the information needed to submit the form and Continue. This will take you to the Program Referral Submission for member selection.
• Follow the remaining steps to create and submit the referral.

Using this feature in Availity also simplifies and expedites the overall case management referral process, while reducing the administrative burden for providers.