Self-Service Hub

Last Updated: Tuesday, June 18, 2024

We value your participation with Highmark and the quality service you provide to our members. We have made significant investments in our self-service tools to reduce administrative burden, improve office workflows, and simplify complex transactions — allowing you and your staff to focus on delivering care to our members.

As a result of this evolution, 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.

Highmark’s Provider Resource Center (PRC): You are here! The PRC is the main hub for you and your staff to review important information and tools, such as EFT registration, policies, procedures, and the Provider Manual.

Highmark’s Provider Portal (Availity): The primary method to submit transactions to Highmark and access reports is through Availity.

Availity Essentials

The following is available via Availity:

Value Insight Center (Value-Based Program Reporting Tool)
Credentialing (Initiate Application, Submit Change, Review Status)
Eligibility and Benefits Check
Authorization Submission
Claim Submissions/Investigations – The use of Availity to check claim status and submit a claim investigation is required.

Interactive Voice Response (IVR) System: The Provider Service Center offers options for you to access information, such as claim status or member benefits, without a live agent.

Provider Service Center

Our wide range of self-service hub available 24/7. Use the below chart as a reference if you are unsure of where to start.

Self-Service Support for Providers

Topic(s)	Inquiry Examples	1st Level Self Service (required for many transactions)	2nd Level Provider or Clinical Service
Authorization Appeals / Grievances	Confirm status of retrospective reviews and appeals Appeal sent but not received Disputing decision	Availity: Status check for Retrospective Reviews & Appeals Peer-to-Peer: (866) 634-6468 to schedule	Contact Regional Provider Service: Contact Page
Authorization & Pharmacy	Urgent or non-urgent prior authorization requests Post-acute discharge Check authorization status	Availity: Submit authorization, check status or make changes Portal Submission Guides: Inpatient Authorization Submission (Both Urgent and Non-Urgent) Outpatient Authorization Submission	Contact Clinical Services or Pharmacy: Contact Page (If services are within 72 hours, Post-Acute or Pharmacy related)
Claims	Claim didn’t process correctly or according to expectation Adjustment has not been completed timely Submitted adjustment bill and claim has been rejected as duplicate rather than adjustment Status of submitted claim	Availity: Claims inquiries/direct messaging (including follow-up to an initial inquiry) Interactive Voice Response: Can be used to check claims status (Contact Page)	Availity: Claims inquiries/direct messaging (including follow-up to an initial inquiry) Interactive Voice Response: Can be used to check claims status (Contact Page)
Contracting	Contract payment was made incorrectly	Contact Regional Provider Service: Contact Page	Contact Regional Provider Service: Contact Page
Eligibility & Benefits	View member ID card Member cost share Deductible renewals New benefit year information	Availity: Benefits and eligibility check	Contact Regional Provider Service: Contact Page
Medical Policy	Medical necessity and coverage guidelines Coding guidance	Provider Resource Center: Commercial Medical Policy Search Tool Delaware New York Pennsylvania West Virginia (Highmark adheres to the Centers for Medicare and Medicaid Services coverage determinations for Medicare Advantage membership.)	Contact Regional Provider Service: Contact Page
Remittance	Didn’t receive file for claims payment Don’t understand file Didn’t get payment file (EFT)	NY Highmark EDI: (800) 992-0246 Highmark EDI: Satisfaction Survey DE, PA,WV ECHO Support: (800) 890-4124 ECHO: User guide	Contact Regional Provider Service: Contact Page

Click on the link below to view Electronic Claims (Submission, Status, and Inquiry)

Electronic Claims (Submission, Status, and Inquiry)Authentication Required

This link requires authentication. If you are not already logged in you will need to log into Availity and link to this site from there.