Highmark wholecare prior authorization

When considering medications from a class included on the Statewide PDL for MA beneficiaries, providers should try to utilize drugs that are designated as preferred.

This information will be used for purposes of performing services to, or on behalf of, our enterprise customers and prospective customers as part of and in relation to matters regarding our provider, health plan, and subsidiary enterprise care delivery, administration and operations. Your email address and phone number may be used to contact you. All reasonably appropriate measures will be taken to prevent disclosure of your Personal Data beyond the scope provided directly or indirectly herein or as may be reasonably inferred from the content contained in this notice or the website. Your Personal Data will be disclosed to appropriate personnel for purposes of performing services to, or on behalf of, our enterprise customers and prospective customers as part of and in relation to matters regarding our provider, health plan, and subsidiary enterprise care delivery, administration and operations. Notwithstanding the above disclosures, we will disclose the Personal Data we collect from you under the following circumstances:. We use third-party service providers to process Personal Data, including, without limitation, for information storage and other similar purposes. These services providers are located in the United States.

Highmark wholecare prior authorization

October 1 — March 31, 8 a. Please note that a representative may contact you to confirm receipt of information. By providing your email you will receive confirmation of your request as well as other helpful information from Highmark Wholecare. Enrollment in these plans depends on contract renewal. Highmark Wholecare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Highmark Wholecare does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Llame al TTY Highmark Wholecare serves a Medicaid plan to Blue Shield members in 13 counties in central Pennsylvania, as well as, to Blue Cross Blue Shield members in 14 counties in western Pennsylvania. Powered by Insightin Health. Need help? Have Medicare and Medicaid?

Have Medicare and Medicaid?

Services centered around you. The services you need to keep your employees healthy. At MedExpress, we understand that accidents and illness can happen anytime. See the information below to help plan your visit to your MedExpress neighborhood medical center. Some exclusions may apply for select insurance plans.

Starting January 1, , Highmark Wholecare will no longer require prior authorization for over services. A listing of the affected Medicare and Medicaid services can be found on our website here. We value your continued partnership and hope this update will help add administrative efficiencies. If you have any questions, please reach out to your Provider Account Liaison. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. You're being redirected to the CMS search site.

Highmark wholecare prior authorization

As a provider, you have access to a wide variety of tools and resources designed to help you deliver better service. If you haven't already done so, follow these simple steps to get the most out of your Highmark Wholecare partnership. Join our network by completing this form. Login to the provider portal. Review and download Medicare Assured and Medicaid Policies. Check out the Provider Newsletter. Highmark Wholecare participating providers have access to our Provider Authorization Portal. Simply access the portal by clicking here. The new Authorization Portal was integrated into the Highmark Wholecare platform that includes all of the functionality of the original and also includes features such as:.

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Payers cover drugs that are listed on their formularies, and drugs that are not included on their formularies are generally not covered. Authorization Requirements. Benefit plans vary widely and are subject to change based on the contract effective dates. Additional information regarding quantity limits for beneficiaries who receive their pharmacy benefits from one of the HealthChoices or Community HealthChoices MCOs is available directly from each MCO. The associated preauthorization forms can be found here. The committee's recommendations are based on the clinical effectiveness, safety, outcomes, and unique indications of all drugs included in each PDL class. Review Data. Questions about authorization workflows. Some preferred drugs on the Statewide PDL require a clinical prior authorization. Notwithstanding the above disclosures, we will disclose the Personal Data we collect from you under the following circumstances:. Enrollment in these plans depends on contract renewal. Highmark will provide written notice when codes are added to the list; deletions are announced via online publication.

Introducing a new provider resource experience that simplifies getting you the information you need, when you need it. Your feedback is appreciated as we work to complete the experience. The authorization is typically obtained by the ordering provider.

Keystones of Health The authorization is typically obtained by the ordering provider. Benefit plans vary widely and are subject to change based on the contract effective dates. We also have resources available for Physical Medicine Management authorizations , which transitioned to Highmark managed in December Highmark Provider Manual. Employer Services. Authorization Requirements. Availity Portal. Get your free kit! Services and Treatment Services centered around you. We want your visit to go smoothly, which is why we offer many convenient options.