Chapter 1 – General Information
The Highmark Provider Manual is designed to be your primary reference guide to Highmark. It contains information, policies, and procedures for all providers participating in Highmark’s provider networks in Delaware, New York, Pennsylvania, and West Virginia, and contiguous counties in their bordering states. The manual combines information for all Highmark service areas to give providers a comprehensive understanding of Highmark’s health insurance programs.
Unit 1: Introduction
The Highmark Provider Manual, together with other administrative requirements as defined or described in the applicable provider agreement, supplements and is made part of your provider agreement(s).
Unit 2: Online Resources & Contact Information
Highmark is committed to providing timely and pertinent information about our policies and programs to the provider community. Highmark has a number of easy-to-use electronic sources of information accessible through your computer as well as service representatives available by telephone.
Unit 3: Electronic Solutions: EDI & Availity
Highmark places a high priority on electronic exchange of information and electronic claims filing. This process is more efficient and cost-effective than conventional means – benefiting health care facilities, professionals, members, and insurers.
Unit 4: Highmark Member Information
Highmark members are individuals who are enrolled in a health plan and meet eligibility requirements, but they can also be subscribers or dependents. Highmark members can be easily identified by the information on their identification (ID) card.
Unit 5: Member Rights & Responsibilities
Members have both rights and responsibilities which vary from state to state and sometimes plan. These rights and responsibilities are made available to members through their Evidence of Coverage (EOC) booklets and updated in member newsletters. Rights and responsibilities are also available in the Appendix of this manual in Chapter 7.
