Self-Service Hub
Last Updated: Wednesday, November 27, 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.
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.
Contact Availity: 800-AVAILITY (282-4548), Monday through Friday, 8 a.m. to 8 p.m. Eastern time.
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.
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.
|
Topic(s) |
Inquiry Examples |
1st Level Self Service (required for many transactions) |
2nd Level Provider or Clinical Service |
|---|---|---|---|
|
Authorization Appeals / Grievances |
|
Availity: Status check for Retrospective Reviews & Appeals Peer-to-Peer: (866) 634-6468 to schedule |
Contact Regional Provider Service: Contact Page |
|
Authorization & Pharmacy |
|
Availity: Submit authorization, check status or make changes Portal Submission Guides: Inpatient Authorization Submission (Both Urgent and Non-Urgent) |
Contact Clinical Services or Pharmacy: Contact Page (If services are within 72 hours, Post-Acute or Pharmacy related) |
|
Claims |
|
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 |
|
Contact Regional Provider Service: Contact Page |
Contact Regional Provider Service: Contact Page |
|
Eligibility & Benefits |
|
Availity: Benefits and eligibility check |
Contact Regional Provider Service: Contact Page |
|
Medical Policy |
|
Provider Resource Center: Commercial Medical Policy Search Tool (Highmark adheres to the Centers for Medicare and Medicaid Services coverage determinations for Medicare Advantage membership.) |
Contact Regional Provider Service: Contact Page |
|
Remittance |
|
NY
DE, PA, WV
|
Contact Regional Provider Service: Contact Page |
Additional information can be found on our Provider Training, Availity, and Electronic Claims pages.
