HealthHelp Transition: Training Sign-Up, Prior Auth Code List, and NY Update

The Oct. 1 HealthHelp transition for genetic/molecular lab testing prior auth review is fast approaching for providers in Delaware, Pennsylvania, and West Virginia.

Note: The start date for New York providers to begin using HealthHelp is moving to later in the year. We will share additional information about the new effective date when it becomes available.

As a reminder, Highmark is engaging HealthHelp, a specialty benefit management company, to assist Highmark in applying evidence-based medical criteria and expert peer consultation to ensure appropriate utilization of molecular lab services.

This transition will apply to your Highmark commercial fully insured, Medicare Advantage, ACA, self-funded Administrative Services Only (ASO) (for DE, PA, and WV only), and Pennsylvania Child Health Insurance Program (CHIP) patients.

Key Reminders

• Training Sessions: To ensure a smooth transition, we encourage providers to sign up for the upcoming HealthHelp training sessions in September. These sessions will provide essential information on the new authorization process. When you register, you will have access to both sessions, giving you the flexibility to attend one or both.
• HealthHelp Landing Page: To further help you and your office prepare for this transition, HealthHelp has a dedicated landing page for Highmark providers where you can access important resources. This page includes the prior authorization code list and frequently asked questions (FAQs) that will help you navigate the new system. We encourage you to review the code list and FAQs prior to Oct. 1.