Prior Authorization Submission Help and Tips

We appreciate your patience as Highmark recently implemented changes to the authorization submission process to simplify the workflow and align with industry standards. We recognize that new system implementations can sometimes present initial challenges, and we appreciate your patience as we work to quickly address some of the glitches you’ve shared with us. 

Key Actions

• Do NOT fax new prior authorization requests. 
• Begin all medical prior authorization requests in Availity Essentials via the Authorizations & Referrals workflow (see below).
• Click the Exit AAH button after you’ve submitted each request. This prevents any potential technical errors.

Use the Patient Registration tab to start your Authorization:

All medical prior authorization requests for inpatient and outpatient services must begin in the Availity’s Authorizations & Referrals workflow, not via Predictal in Payer Spaces. 

I am unable to submit due to an error.

If you have trouble submitting an initial prior authorization in the new workflow, do not fax your submissions. Please reach out to Availity Client Services at 800-242-4548. We have limited staff available to process faxes, so portal requests remain the best channel for faster determinations.  

I completed the request but am unsure it was submitted.

If you have already submitted a prior authorization request via any channel, do not resubmit, or it will lead to further delays. Check the Availity’s Authorization Dashboard or Auth Inquiry periodically as we work through our current inventory.

Tips

• After entering your initial information, you may be prompted to Continue Request in Predictal.  You will be automatically redirected to Predictal to review the imported data and add any necessary sub-services.
• Click the Exit AAH button after you’ve submitted each request. This prevents any potential technical errors.

When to Still Use Predictal via Highmark's Payer Spaces in Availity Essentials:

• Submitting Extensions and Concurrent Requests 
  • Note: Home Health Care recertifications are considered “new submissions” and go through the Authorizations & Referrals workflow, not the Predictal tile in Payer Spaces.
• Viewing authorizations via Auth Inquiry that were previously submitted via phone or fax.
• Reviewing approval or denial letters.
• Submitting discharge requests.
• Responding to requests for additional information.
• Pharmacy Authorization Requests: Continue to use CoverMyMeds.