Professional Credentialing

Last Updated: Monday, October 05, 2026

Highmark requires all professional providers to utilize the Council for Affordable Quality Health Care (CAQH) ProView^® for initial applicant registration.

When credentialing with Highmark, the enrollment process follows the steps outlined below, which include completing your CAQH profile and submitting the initial credentialing request to join our network.

Step 1: Initial Applicant Registration

Applicant Type No results were found for the keyword entered.	Requirement No results were found for the keyword entered.	Action Required on the CAQH Website No results were found for the keyword entered.
New Applicant (No CAQH provider ID) No results were found for the keyword entered.	Create Your CAQH ProView^® Profile No results were found for the keyword entered.	Complete the full application to obtain your CAQH ProView^® ID. No results were found for the keyword entered.
Existing Applicant (Has a CAQH provider ID) No results were found for the keyword entered.	Update Your CAQH ProView^® Profile No results were found for the keyword entered.	Review your data on the CAQH Portal and complete the necessary re-attestation. No results were found for the keyword entered.

Note: In all cases, you must authorize Highmark to access your data electronically.

Step 2: Join Highmark Network

Begin credentialing by submitting your initial request via the CertifyOS Provider Portal. Below is a guide on portal usage, including initial account creation, dashboard navigation, and submitting a credentialing application.

CertifyOS Provider Portal User Guide

Note: If you are a general dentist (DDS/DMD), physician, or allied provider, review the information further down on this page for credentialing guidance specific to those practitioners.

Step 3: Before Billing

Highmark requires providers to be affiliated with a billing practice. To complete this step, use the appropriate form:

Request for New Billing Practice (Assignment Account) – Use this form when you need to create a billing account for your practice.
Request to Add a New Practitioner to an Existing Practice – Use this form to update a practitioner's affiliation with an existing participating practice (Assignment Account), enumerate advanced practice providers (APPs) within Highmark's reimbursement systems, and add a practitioner to an existing Assignment Account when their services are exclusively provided to members within participating skilled nursing facilities, ambulatory surgery centers, inpatient hospitals, and/or freestanding inpatient or outpatient facilities.

Step 4: Return Contract

If you are joining a new group or network, billing may begin only after a professional group agreement is complete and your participation effective date has been established. Return the completed contract to Highmark using the Contract Upload Form.

Important: Credentialing approval alone does not authorize billing. Before submitting claims, the following requirements must be met:

A professional group agreement is in place.
A welcome letter confirming effective participation date has been received.

General Dentists (DDS/DMD), Physicians, and Allied Providers

If the practitioner is a general dentist (DDS/DMD) ...

Follow the guidance below based on type of services provided.

Dental services only: Complete credentialing through United Concordia.
Medical or surgical services: Complete Highmark credentialing via the CertifyOS Provider Portal.
Medical or surgical services (inpatient only): Complete the Facility-Based Provider Affirmation Statement.

If the practitioner is a physician or allied provider …

Follow the guidance below based on answers to these questions:

Where does the practitioner provide services?

Inpatient only: Complete the Facility-Based Provider Affirmation Statement.
Medical practice only, or both medical practice and inpatient: Credential via the CertifyOS Provider Portal.

Does the practitioner require credentialing?

Yes: Follow the standard professional practitioner credentialing process and proceed with the applicable credentialing requirements via the CertifyOS Provider Portal.
No: If the practitioner is an advanced practice provider (APP), complete the Advanced Practice Provider Enumeration Form.

Does the group the practitioner is joining have an Assignment Account or Billing Account?

Does the practitioner have a CAQH ID?

Yes: Confirm the CAQH application is current, has been re-attested, and Highmark is authorized to receive the practitioner's information before proceeding.
No: Obtain a CAQH ID, complete the CAQH application, and authorize Highmark before submitting the credentialing request.

Credentialing Details

Application Deadline

Processing Time

Highmark completes credentialing in accordance with all federal, state, and regulatory requirements. Our goal is to complete initial credentialing within 45 days of receiving a complete application. Processing times may vary if additional information is needed or during periods of high application volume. We appreciate your patience as we work to ensure accurate and compliant credentialing.

Contract Request

Group Request

Communication

Post-Submission and Status

I Want to … No results were found for the keyword entered.	How to Proceed No results were found for the keyword entered.	More Details No results were found for the keyword entered.
Get in Touch with the Team No results were found for the keyword entered.	Provider Service Center No results were found for the keyword entered.	For all your credentialing inquiries, call your regional Provider Service Center and select the Credentialing option from the IVR menu. No results were found for the keyword entered.
Check Application Status No results were found for the keyword entered.	Credentialing Status Inquiry Form No results were found for the keyword entered.	This form is for credentialing and recredentialing status inquires ONLY, all other questions will not be reviewed and responded. No results were found for the keyword entered.
Submit Facility-Based Details No results were found for the keyword entered.	Facility-Based Provider Affirmation Statement No results were found for the keyword entered.	Providers who deliver care exclusively within an acute care hospital must complete the Facility-Based Provider Affirmation Statement. No results were found for the keyword entered.
Update Information No results were found for the keyword entered.	Provider Information Management (PIM) Forms No results were found for the keyword entered.	CAQH is only for credentialing. Use provider portal or PIM Forms to update your data (location, contact, etc.). No results were found for the keyword entered.

Additional Resources

Highmark Provider Manual – See Chapter 3 for detailed information on Provider Network Participation.
Provider Guide to Credentialing

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New York Group Contracts

Highmark is in the process of moving professional providers in its New York markets onto Highmark Professional Agreements – which are group contracts that match the structure that is in place in the other Highmark service regions.

For more information, read our Frequently Asked Questions.