Organizational Credentialing

Get in Touch with the Team

Provider Service Center

For all your credentialing inquiries, call your regional Provider Service Center and select the Credentialing option from the IVR menu.

Change address or contact details.

Highmark Facility/Ancillary Change Form

Useful for UB Facility Billers, Urgent Care Centers/Medical Aid Unit/Retail Clinics, or for Organizational Behavioral Health Billers.

Check the status of my credentialing application.

Credentialing Status Inquiry Form

This form is for credentialing and recredentialing inquires ONLY; all other questions will not be reviewed.

Request special consideration to join a closed specialty.

Special Consideration Questionnaire

Complete the special consideration questionnaire for review before credentialing can begin.

Note: If you select a specialty that is closed, you may request special consideration by completing the Special Consideration Questionnaire. Requests are reviewed by Contracting and may be approved as exceptions when appropriate. Closed Specialties include: Hospice, In-Home Supportive Care, Laboratory, Orthotics and Prosthetics, Specialty Pharmacy, Urgent Care Center/Medical Aid Unit, and Skilled Nursing Facility.

Formally update the organization's ownership details.

Change of Ownership (CHOW) Form

Useful for providers to report any changes which may include the Legal Name, Doing Business As name, NPI, or Tax ID information.

Non-participating Facility and Ancillary Providers can report information when requesting payment for rendered services.

Non-Par Provider Request Form

This form is intended for hospital, facility, and ancillary medical entities that do not wish to contract with Highmark but need to submit essential information so that claims can be processed and payment issued when services are rendered.

Find the complete list of credentialing and enrollment related forms.

Provider Information Management (PIM) Forms

To maintain accurate provider records, access the PIM forms to submit changes for demographics, practice locations, affiliations, specialties, and panel status.

Get credentialing requirements.

Organizational Provider Participation, Credentialing, and Contracting Requirements

Useful for providers to review credentialing requirements based on organizational provider type.

Review all details on network eligibility, data management and cooperation requirements.

Highmark Provider Manual

Chapter 3 covers all aspects of provider network participation, including credentialing, recredentialing, and facility/ancillary guidelines.