Medical Policies
Navigate coverage easily with integrated procedure and diagnosis codes.
Highmark Medical Policy Search
Find comprehensive medical policy guidelines for all of Highmark’s medical-surgical products, including managed care.
Medicare Advantage Policy Search
Highmark adheres to the Centers for Medicare and Medicaid Services (CMS) coverage determinations for Medicare Advantage (MA) membership.
Medical Policy Update
This monthly publication focuses only on medical policy and claims administration updates, including coding guidelines and procedure code revisions, and is the sole source for this information.
Additional Resources
Preferred Products for Medicare Advantage
Preferred products help lower drug prices while maintaining access to covered services and drugs.
MCG Clinical Criteria
Highmark has incorporated MCG Health evidence-based clinical guidelines into our criteria of clinical decision support.
Care Management
Mission Statement
The Medical Policy Department's mission is to develop and maintain evidence-based coverage guidelines.
Additional Help
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.
