Care Management
Our programs offer an integrated approach to healthcare coordination, so members get the right care in the right setting.
Care Management Programs
Highmark works with our partners to deliver best-in-class care management programs.
Advanced Imaging & Cardiology
This program incorporates a comprehensive, clinical review including predictive intelligence, clinical decision support, and peer-to-peer discussions.
Laboratory Management
Developed with trained experts, this program uses evidence-based policies to ensure that lab services provided to members support clinically appropriate care and are medically necessary.
MSK & IPM
Highmark works with its partners to perform utilization management and handle prior authorizations for musculoskeletal surgical procedures and interventional pain management procedures.
Radiation Therapy Authorization
This program ensures that radiation oncology therapy services provided to our members are medically necessary and consistent with nationally recognized clinical guidelines.
Physical Medicine Services
Our partners work with Highmark to help ensure that outpatient physical medicine services (physical therapy, occupational therapy, and manipulation services) are consistent and medically necessary.
Post-Acute Care for Medicare Advantage Members
We support Medicare Advantage members through post-acute care management and transitions to long-term acute care, inpatient rehab, and skilled nursing utilization.
More Care Management Programs
Behavioral Health
Highmark's Behavioral Health Program helps to link members to appropriate care for mental health/substance use disorder conditions.
Enhanced Community Care Management
ECCM is a non-billable coordinated care service designed to support the most complex and vulnerable patients. The goal is to help them live their best lives possible while maintaining their independence.
Right Care Program
Right Care is a Highmark clinician-led program to reduce clinical variability and improve outcomes, experience, and appropriateness of care. It’s done to make sure our members receive the right care, at the right place, and the right time.
Authorization Support
Availity Portal
Have questions about Availity? Get help with portal actions or navigation, registration, access, error messages, and more.
Authorization Workflows
Need help with authorization workflows? If an authorization number is not appearing, you're unable to locate a member, or have questions about a clinical criteria screen, email us.
Authorization Status
To check the status of submitted authorizations:
1. Use the Predictal Auth Automation Hub within Highmark’s Payer Spaces in Availity.
2. If you can't find what you need in Availity, call Highmark Clinical Services and press 2 for authorizations.
Fax
If you're unable to use Availity, you can also fax your authorization requests. Find the prior authorization forms you need here.
Provider Service Center
Can't find an answer? Call us: 8 a.m. to 5 p.m. EST, Monday through Friday.
Clinical Services
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.
