Provider Training

These trainings are a great way to give current staff helpful information about Highmark policies, programs, and procedures.

If you are a newly contracted provider, or a new employee of a network provider's office or facility, please visit our orientation page to view resources we make available to help you in your interactions with Highmark and our members. 

PROVIDER ORIENTATION

Highmark member rights and responsibilities are included in the Highmark Provider Manual, which is housed here on the Provider Resource Center. A paper copy will be provided upon request.

In October 2024, Highmark launched a new, consolidated Provider Resource Center with a streamlined layout, improved site search, regional information, and a focus on your top tasks. For the best experience, choose your region in the upper right hand corner. And, for full access, log in via Availity. Use the PRC User Guide below for additional help.

PRC User Guide

Highmark's provider portal, Availity, is available to all participating providers. Availity is an internet-based application for providers to streamline data exchanges between their offices and health insurance companies. Providers who are not currently registered to use Availity should register using the following link: Register and Get Started with Availity Essentials

For additional information about Availity, click the link below.

The Centers for Medicare and Medicaid Services (CMS) requires of Highmark and its network providers that current, accurate provider data is published in Highmark's Provider Directory. 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.

Additional information and resources on maintaining accurate provider data are available at the links below.

• Provider Data Maintenance (PDM) Guide

Every quarter, CMS requires Highmark to reach out to you to validate your Provider Directory information. The attestation process for facility, ancillary, and Medicaid providers is done through Atlas, an independent company that conducts the outreach on our behalf.

Atlas Prime-Hub Self Service Guide

NOTE: Professional providers should validate their Provider Directory information within PDM every 90 days.

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 Authorizations page:

Highmark uses Availity Essentials, a secure, full-service web portal that offers electronic solutions at no charge for providers to perform essential claim processes. For more information and resources, go to the Electronic Claims page:

This training is a 4-step process. Please review each link in order. After Step 3, open the link for the Training Attestation.

Step 1:Highmark Training

Step 2:Medicare Parts C and D General Compliance Training

Step 3:Combating Medicare Parts C and D Fraud, Waste, and Abuse

Step 4:Training Attestation

• Once you meet the program requirements, an authorized representative of your organization can complete and retain a copy of the attestation form above for your records.

• Joint Administration Solutions (JAS) Reference Sheet