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- Latest Updates
Provider News
Provider News is a valuable resource for health care providers who participate in our networks. Published monthly on the last Monday of the month, Provider News conveys important product, policy, and administrative information, including billing, claims, and program updates.
The publication also features the latest news, information, tips, and reminders about our products and services, as well as relevant interviews, articles, and stories, for health care professionals who serve Highmark members.
Regular topics include:
- New and Updated Reimbursement Policies
- Authorization Updates
- Staying Up to Date with the Highmark Provider Manual
For medical policy and claims administration updates, including coding guidelines and procedure code revisions, be sure to read our Medical Policy Update.
Please Join Our Mailing List to receive an email notification when the latest issue is available online.
Showing 1 - 10 of 31 results for ""
Published Date: Monday, March 31, 2025
picture_as_pdfIssue 3, March 2025
- Electronic Enhancements: 3 Ways Prior Auth Is Getting Easier and Faster
- Reimbursement Changes for Highmark Inpatient DRG Methodologies for Acute Care Facilities
- Four Reimbursement Policies to be Updated on May 30, 2025
- Quick Claims Just Got Quicker: Expanded Payer Options for Senior Health and Senior Solutions
- Latest Edition of MCG Care Guidelines
- Short Takes: Unsolicited Attachments in Availity, MID Reimbursement, and More
- Credentialing Communication: Your Email Is Key
- HEDIS Reporting: Transition to ECDS-Only Reporting Underway
- Reducing Readmissions: A Practical Guide for Medical Providers and Office Staff
- Population Health Management – Helping Members Achieve Better Health
- New and Updated Reimbursement Policies
- Important Highmark Reminders: Utilization Review, Patient Notification, Member Rights, and More
- Quarterly Formulary Updates
- Staying Up to Date with the Highmark Provider Manual
- Directory Information – Here’s How to Attest
Published Date: Monday, February 24, 2025
picture_as_pdfIssue 2, February 2025
- Electronic Claims Update: Supporting Documents Can Be Attached When Submitting New Claims in Availity
- Annual HEDIS Medical Record Reviews to Begin in February 2025
- POSTPONED: Authorization Enhancement for Physical Medicine, Home Health, and Hospice Requests
- 2025 Gold Card Program Expansion: Streamlining Prior Authorizations for Providers
- Provider Live Chat in Pennsylvania Resumed Earlier This Month
- Collaborating to Improve Your Patients’ Health and Experience
- Colorectal Cancer Awareness Month: Enhance Patient Care and Close HEDIS Gaps
- Short Takes: Fee Schedules, Psychologist Credentialing, and More
- New and Updated Reimbursement Policies
- Directory Information – Here’s How to Attest
- Staying Up to Date with the Highmark Provider Manual
Published Date: Monday, January 27, 2025
picture_as_pdfIssue 1, January 2025
- Highmark’s Preventive Health Guidelines Updated for 2025
- Auth Enhancement: Specific Codes Required for Physical Medicine, Home Health, and Hospice Requests
- Highmark EPO Network: Important Reminder for Providers
- Temporary Pause: Successful Provider Live Chat Pilot in Pennsylvania
- Short Takes: HEDIS Changes, MID Reimbursement, and More
- Heart Health Month: Preventing Cardiovascular Complications for People with Diabetes
- Authorization Updates
- New and Updated Reimbursement Policies
- Quarterly Formulary Updates
- Directory Information – Here’s How to Attest
- Staying Up to Date with the Highmark Provider Manual
Published Date: Monday, December 30, 2024
picture_as_pdfIssue 12, December 2024
- Availity Best Practices: Instructional Videos, Guides, and More
- True Performance Lite: Enhanced Capabilities in 2025
- Reimbursement Changes for Some Medical Injectable Drugs
- Cervical Cancer Prevention: Patient Education and HEDIS Documentation
- Highmark’s Healing at Home Supplemental Benefit
- Live Chat Pilot for Pennsylvania Providers Recently Launched
- Short Takes: Provider Accessibility, Helion Prior Auth End Dates, and More
- Authorization Updates
- New and Updated Reimbursement Policies
- Formulary Updates
- Staying Up to Date with the Highmark Provider Manual
- Directory Information – Here’s How to Attest
Published Date: Monday, November 25, 2024
picture_as_pdfIssue 11, November 2024
- Electronic Claims: Get Paid Faster
- Simplifying Prior Authorization with Active Gold Carding and Other Innovations
- Short Takes: CHIP Member ID Cards, MA Out-of-Area Members, and More
- Diabetes and Kidney Disease: A Comprehensive Approach to Patient Care
- Is Your PROMISe ID Up to Date?
- Care Coordination Leads to Better Patient Outcomes
- Cultural and Language Resources on the PRC
- Authorization Updates: Changes in the New Year
- Medical Injectable Drug to Require Prior Authorization on Jan. 1, 2025
- New and Updated Reimbursement Policies
- Directory Information – Here’s How to Attest
- Staying Up to Date with the Highmark Provider Manual
Published Date: Monday, October 28, 2024
picture_as_pdfIssue 10, October 2024
- Prior Authorization Changes in the New Year
- HEDIS Tips: 5 Ways to Close Gaps in the Next 60 Days
- Empowering Your Patients with My Highmark
- Short Takes: ED Claim Audits Reminder, Medicare PrEP Change, and More
- Survey Says: How CAHPS Can Help Improve the Patient Experience
- Mental Well-Being Solution for Low-Acuity Needs
- Authorization Updates
- New and Updated Reimbursement Policies
- Directory Information – Here’s How to Attest
- Staying Up to Date with the Highmark Provider Manual
picture_as_pdfIssue 9, September 2024
- The New PRC Officially Launches Tomorrow
- New Predictal Enhancement Will Streamline Authorization Process
- Approved Authorizations: Automated Call System to Notify Members and Providers
- Preventive Health: Annual Screening for Breast Cancer
- Revised Prescription Medication Policy for Weight Loss Medications
- Short Takes: MA Medical Policy Search, Express Scripts, and More
- HEDIS Tips: CPT II Coding for Diabetes, Hypertension, and Pregnancy-Related Care
- Non-Par Providers: Self-Service Requirement for Claim Status and Claim Inquiry Moving to February
- Medical Record Retrievals
- October Coding Webinar: Depression
- Authorization Updates: Injectable Drug to Be Added to PA List, Medical Auth Faxes, and More
- New and Updated Reimbursement Policies
- Quarterly Formulary Updates
- Directory Information – Here’s How to Attest
- Staying Up to Date with the Highmark Provider Manual
picture_as_pdfIssue 8, August 2024
- Faxes Being Phased Out; Prior Auth Requests Must Be Submitted via Availity Effective Oct. 1
- A New Centralized PRC for All Six Highmark Regions to Launch This Fall
- New Colon Cancer Test NOT on the Highmark Preventive Schedule
- Short Takes: Tips for Corrected Claims, Immunization Awareness, and More
- Protect Your Youngest Patients: Why Two Flu Shots Are Better for Children 6 Months – 8 Years Old
- Non-Participating Providers Required to Use Self-Service Tools for Claim Status and Claim Inquiry
- New Social Determinants of Health (SDOH) Quality Guide
- FEP Members Are Getting New ID Cards
- Reminder: Filing Contiguous County Claims for Highmark Members and Non-Highmark Members
- New and Updated Reimbursement Policies
- Authorization Updates: Out-of-Area Exceptions, MSK Bilateral Reminder, and Sept. 30 Changes
- Directory Information – Here’s How to Attest
- Staying Up to Date with the Highmark Provider Manual
picture_as_pdfIssue 7, July 2024
- Two Key Self-Service Tools: Claim Status and Claim Inquiry in Availity
- A Conversation with Jerry Walsh, Senior Vice President of Provider Contracting
- Timely Access to Support: Coding for Optimal Care
- Encouraging Medicare Patients to Improve Health Outcomes
- Short Takes: Fee Schedules, Express Scripts, and Spring Health Webinar
- HEDIS Measure: Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis
- Behavioral Health: 7 Tips for Authorization Request Approvals
- Authorization Updates
- New and Updated Reimbursement Policies
- Formulary Updates
- Directory Information – Here’s How to Attest
- Staying Up to Date with the Highmark Provider Manual
picture_as_pdfIssue 6, June 2024
- 2024 Mid-Year Preventive Schedule
- Combating Childhood Obesity: 5 Effective Strategies
- Save the Date: Mental Well-Being powered by Spring Health Webinar
- Short Takes: Highmark Health Options, High Performing Provider Program, & More
- Low Back Pain: Reducing Unnecessary Imaging
- Working to Meet Patients’ Language Needs
- July Coding Webinar: Cancer
- Key FAQs: Medicare Compliance Training
- Authorization Updates
- Medically Unlikely Edits: Providers Must Bill for Individual Dates, Instead of Span Dating
- Corrected Claim Process Update: Changes Will Go Directly on Replacement Claim
- New and Updated Reimbursement Policies, Including Changes to RP-051
- Quarterly Formulary Updates
- Directory Information – Here’s How to Attest
- Staying Up to Date with the Highmark Provider Manual
