Find out how to submit, update, and inquire about authorization requests.
Before you submit for prior authorization on Availity, we recommend that you consult Member Eligibility & Benefits. If you don’t have access to Availity, you can review other options below.
We maintain evidence-based coverage guidelines and monitor evolving therapies to ensure appropriate benefit adjudication, patient safety, and optimized treatment.
Highmark offers a wide range of care management programs and policies.
Find clinical guidance for certain treatments from eviCore.
Find information on how Highmark incorporates MCG Health evidence-based clinical guidelines into our clinical decision support criteria.
Find the forms you’ll need in order to fax your prior authorization request.
Use HIPAA Health Services Review (278) electronic transactions for authorizations.
Have a question about the Auth Automation Hub? Refer to our FAQ.
Get answers to your questions about Availity portal actions, including registration, user access, account assistance, portal navigation, and error messages.
Find answers to questions about authorization workflows, authorization numbers not appearing, members who can't be located, and clinical criteria screens.
Use the Predictal Auth Automation Hub within Highmark’s Payer Spaces in Availity. For Inpatient Planned Requests, call the number below & press 2 for authorization requirements/status.
Can't find an answer? Call us: 8 a.m. to 5 p.m. EST, Monday through Friday.
Still have questions? Call us: 8:30 a.m. to 7 p.m. Monday through Friday, 8:30 a.m. to 4:30 p.m. Saturday and Sunday.