Provider Onboarding

Interested in participating in our provider networks? Start by visiting our Credentialing page.

• For more information about participating in our networks, see Highmark Provider Manual – Chapter 3.
• For credentialing questions, call your regional Provider Service Center and select the Credentialing option from the menu.

Sign up to receive your claim payments and ERAs electronically through PNC ECHO: 

• Create an Account 
• Quick Reference Set-Up Guide

Providers who have not registered to accept payments electronically will receive virtual credit card (VCC) payments with their Explanation of Benefits (EOB). Providers may opt out of VCC by visiting/calling ECHO Health at 800-890-4124.  

Explore more details about ECHO's payment options on  ECHO Health’s platform. 

More information can be found in the Highmark Provider Manual:   

• Electronic Transaction Requirements (Chapter 1, Unit 3)  

Highmark uses Availity Essentials, a secure, full-service web portal that offers electronic solutions at no charge for providers to perform essential claim processes.   

You may also submit claims using HIPAA 837 electronic transactions through your clearinghouse or practice management system, leveraging Highmark’s Electronic Data Interchange (EDI). Click on the link for your region below: 

• Delaware 
• New York 
• Pennsylvania 
• West Virginia 

For more information, go to the Electronic Claims page. 

All network participating providers are required to register for our provider portal, Availity Essentials , to submit transactions to Highmark. 

Access the following resources: 

• Register and Get Started with Availity Essentials 
• Availity Essentials Guidance  

The Provider Directory is an important tool that helps our members contact practitioners, and the data itself is what drives timely and accurate claims processing.  The Centers for Medicare and Medicaid Services (CMS) requires Highmark to reach out to you every quarter to validate your Provider Directory information. 

NOTE: All providers should validate their Provider Directory information within Provider Data Maintenance, accessible via Highmark’s Payer Spaces in Availity, every 90 days. 

Additional information and tools to assist you in maintaining accurate provider data are available on the Provider Data Accuracy Compliance page.

The Highmark Facility / Ancillary Change Form is also provided on the Provider Data Accuracy Compliance page for our participating facilities and ancillary providers.

Highmark requires authorization of certain services, procedures, and/or Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) prior to performing the procedure or service.  

For more information and resources on prior authorization, go to the Obtaining Authorization page. 

The PRC is the central location for helpful information, including the Highmark Provider Manual and the Communications Hub. See additional links for the PRC in the next section.

• Medical Policies – Highmark's medical policy guidelines address medical services, including diagnostic and therapeutic procedures, injectable drugs, and durable medical equipment.  

• Pharmacy Programs – Ensure that members have access to the right medications, while managing costs, billing, and reimbursements. 

• Preventive Health Guidelines – A reference tool to assist you in planning your patients’ care. 

• Forms – Find all your necessary Highmark forms here.  

For the best PRC experience, choose your region from the upper right corner. And for full access, log in via Availity. 

Don’t miss important network information. Have it sent straight to your inbox by signing up to receive our monthly provider newsletter and other e-mail notifications.

You can click Join Our Mailing List at the top of any page of the PRC to join.

Highmark requires providers to utilize our enhanced self-service tools to obtain the fastest resolution to many common issues and tasks. This allows our Provider Service advocates to assist with more complex issues and your staff avoid unnecessary hold times on the telephone. 

Learn more about our tools in our Self-Service Hub.

For issues that cannot be resolved using our self-service tools, call your regional Provider Service Center.