Provider Orientation

If you are a newly contracted provider, or a new employee of a network provider's office or facility, we would like to introduce you to the many resources we make available to help you in your interactions with Highmark and our members. 

• History of Highmark
  
• Highmark's Mission, Vision, and Values

Register for Availity Essentials - Our Provider Portal

All network providers are required to register for our provider portal, Availity Essentials, to submit transactions to Highmark. Review the Availity section of the Provider Resource Center (PRC) for more information regarding training and support.

Register on Availity

Enroll in Electronic Funds Transfer (EFT) and Electronic Remittance Advices (ERAs)

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

Providers who have not registered to accept payments electronically will receive virtual credit card (VCC) payments with their Explanation of Benefits (EOBs). Providers may opt out of VCC by completing the form below or by calling ECHO Health at (800) 890-4124. You may also opt out of VCC in ECHO's Payer Control Portal by entering your Tax Identification Number (TIN) in the Tax ID Processing Options with a No Virtual Card rule.

• Sign up for the PNC ECHO payment system.
• Read the PNC ECHO quick reference set-up guide.
• Opt out of Virtual Credit Card (VCC) payments by completing this form.

Providers needing additional assistance may call Provider Service.

• For additional assistance contact Provider Service.

More information can be found in the Highmark Provider Manual:

Don’t miss important network information. Have it sent straight to your inbox by signing up to receive our monthly Provider Newsletter and joining our mailing list.

The Provider Resource Center (PRC) is the central location for helpful information such as:

• The Highmark Provider Manual
  • BlueCard (Chapter 2, Unit 6)
  • Fraud Prevention (Chapter 6, Unit 8)
• Important Announcements and Updates
• Prior Authorization Requirements
• Claims & Reimbursement Policies
• Medical Policy
• Pharmacy Policy
• Forms
• Provider Newsletters

Our PRC and provider portal, Availity, are the best options to find critical information. If you need something that cannot be self-serviced, you may contact customer service advocates using the Contact Information for your particular region.

Provider and Clinical Services Contact Information

Please review our Provider Training page below for additional helpful information about Highmark policies, programs, and procedures.

Highmark continually strives to enhance the quality of care and service to our members. One of the ways this is accomplished is via our Highmark Preventive Health Guidelines.

The guidelines are reviewed annually and updated to ensure they remain current with national guidelines, as well as with national, regional, and local standards of medical care. The guidelines are distributed to the practitioner community as a reference tool to encourage and assist you in planning your patients’ care. Coverage of the preventive/wellness benefits are subject to the terms of the member’s benefit plan.

And finally, please be sure to report any changes to us regarding your office, facility, or participating care providers! Visit our Provider Data Accuracy Compliance page for requirements for accurate, up-to-date provider data in our Provider Directory and instructions on how to make any changes to your information on file with us.

The Provider Data Maintenance (PDM) and Provider File Management (PFM) guides assist professional providers in reporting changes via Availity.

• Provider Data Maintenance (PDM)
• Provider File Management (PFM)

The Highmark Facility/Ancillary Change Form is to be used by UB Facility Billers, Urgent Care Centers/Medical Aid Unit/Retail Clinics, or for Organizational Behavioral Health Billers to report a change in DBA/legal name, NPI/TAX ID, an address update, or a change in phone number.

• Highmark Facility/Ancillary Change Form

Note: If you are not yet contracted with Highmark and are interested in participating in our provider networks, you can start by visting the Credentialing page.

CREDENTIALING PAGE

You can also find participation information in Chapter 3 of the Highmark Provider Manual. 

HIGHMARK PROVIDER MANUAL

Contact Provider Services in your service area with any questions.

Provider and Clinical Services Contact Information