Provider Orientation
Last Updated: Tuesday, December 10, 2024
Welcome to Highmark!
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.
Get to Know Us
Start Working With Us
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.
Enroll in Electronic Funds Transfer (EFT) and Electronic Remittance Advices (ERAs)
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Sign up to receive your claim payments and ERAs electronically through PNC ECHO:
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 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.
Providers needing additional assistance may call Provider Service.
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After becoming Availity-enabled, providers must also enroll in electronic funds transfer and paperless electronic remittance advices. To do this, please contact Provider Service.
Provider Communications
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.
Tools and Resources
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
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Onboarding Resources
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Click the links below to access information from Highmark staff on how to begin working with us.
- General Overview/Onboarding for All Providers - Southeastern PA only
- Medical Policy/Utilization Management Overview for Facilities | Video – Southeastern PA only
- Medical Policy/Utilization Management Overview for Professional and Ancillary – Southeastern PA only
*Onboarding/training materials for other states/regions available soon.
Video Disclaimer
*By accessing the videos above, I understand that I am leaving the Highmark PRC website and will be redirected to an external website operated by a third-party platform provider. Any use of the third-party platform provider’s website and any information you provide will be subject to and governed by the terms of the third party, including those relating to confidentiality, data privacy, and security.
Provider and Clinical Services
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 Training
Please review our Provider Training page linked below for additional helpful information about Highmark policies, programs, and procedures.
Preventive Health Guidelines
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.
Provider Directory
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.
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The Provider Data Maintenance (PDM) and Provider File Management (PFM) guides are available to assist professional providers in reporting changes via Availity.
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The Provider Data Maintenance (PDM) Guide is available to assist professional providers in reporting changes via Availity.
The Highmark Facility/Ancillary Change Form is also provided on the Provider Data Accuracy Compliance page for our participating facilities and ancillary providers.
Thank you for your support and for providing high-quality care to our members, your patients. Welcome to Highmark – we look forward to working with you!
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.
You can also find participation information in Chapter 3 of the Highmark Provider Manual.
Contact Provider Services in your service area with any questions.
Provider and Clinical Services Contact Information
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*By accessing this video, I understand that I am leaving the Highmark PRC website and will be redirected to an external website operated by a third-party platform provider. Any use of the third-party platform provider’s website and any information you provide will be subject to and governed by the terms of the third party, including those relating to confidentiality, data privacy, and security.
