NaviNet is a free, Internet-based application for providers to streamline data exchanges between their offices and Highmark. The waiver of Highmark member cost-sharing for in-network telehealth visits is effective for electrolysis amerigroup of service from March 13 international claims June 30, Please carefully read and follow the instructions contained within the individual form for submission. Health Options Provider Manual. Medical Policy Medical Policy. This partnership is instrumental in bringing a personalized care transitions approach to support Highmark's Medicare Advantage members across Pennsylvania and West Virginia. Contact Us.
Durable medical equipment DME. Total joint replacement exception request - Specific to Washington small group members requesting a provider or facility that isn't a Premera-Designated Center of Excellence for total knee or hip replacement.
Pharmacy pre-approval request. Opioid attestation — Specific to School Employees Benefits Board SEBB members undergoing active cancer treatment, hospice, palliative care, end-of-life, or medically necessary care who might be exempt from quantity limits. For expedited authorization codes, call Premera pharmacy services at ProviderSource is free and requires:. View our practitioner credentialing checklist or the Join Our Network page for more information. Behavioral health specialty addendum - Provide us with your behavioral health primary areas of clinical expertise.
Dental provider credentialing application — Request to join our dental provider network. Provider update - Email this form to Premera with new information or changes to your current practice or payment structure. The federal No Surprises Act requires health plans to verify all provider directory data every 90 day. It also requires all providers and facilities submit this information to in-network plans. Unverified providers may be removed from our directory.
Email us your completed documents. The credentialing process typically takes 30 days. Acceptance is based on your application information and network requirements. If your submitted application is accepted, you'll receive a contract to review and sign. The completed form must be submitted to Premera before the member receives services from a specialist.
The checklist must be completed before claims are processed. Current location: WA Alaska. Provider Forms Browse a wide variety of our most frequently used forms. For additional member forms, view our specific plan pages: Individual plans. Appeals Provider appeal submission with authorization - Resolve billing issues that directly impact payment or a write-off amount.
Policy reconsideration Policy reconsideration - Request reconsideration of a coding policy. Claims and billing. Processing or correcting claims Corrected claim cover sheet - Correct billing info, codes or modifiers, or add an EOP on a previously processed claim. Billing Balance billing protection act dispute — Providers or facilities not contracted with Premera can submit a balance billing dispute request.
Care management and prior authorization. Care management Admission notification and discharge notification Prior authorization and pre-approval Learn more about submitting prior authorization , including for DME. General prior authorization request Out-of-network exception request - Request in-network benefits for an out-of-network service.
Durable medical equipment DME Infusion drugs Total joint replacement exception request - Specific to Washington small group members requesting a provider or facility that isn't a Premera-Designated Center of Excellence for total knee or hip replacement.
In addition, to expand options to access testing, Highmark members can use their existing pharmacy network to receive over-the-counter tests without any up-front costs, eliminating the need for reimbursement see below for more information on this option.
Note: Tests may be packaged individually or with multiple tests in one package for example, two tests packaged in one box.
Plans are required to cover 8 tests per covered individual per 30 days, regardless of how they are packaged and distributed. Highmark members with employer-sponsored or individual health insurance coverage can seek reimbursement for the purchase of FDA emergency use authorized over-the-counter COVID tests. Highmark Medicare Advantage members are not eligible for reimbursement at this time. The Biden Administration did not include Medicare in the coverage requirements.
However, beginning April 4, individuals with Medicare Part B can get up to eight free over-the-counter tests every calendar month through the end of the COVID public health emergency from participating pharmacies or health care providers. Click here for additional information regarding Medicare over-the-counter test coverage. Highmark Medicare Advantage members can also receive up to 24 free tests through the federal government website covidtests.
Please note that there are currently limited supplies and tests may take up to 4 weeks to arrive. Note: If you do not have prescription coverage through your Highmark plan, please verify options with your employer. Note: supplies may be limited, and tests may not be available at all retail pharmacy locations. To locate an in-network pharmacy members can visit the Highmark member website or call the number on the back of their Highmark insurance card or pharmacy benefit card for help.
Just follow the step-by-step instructions found below to submit your claim via mail or through our online member portal.
Members can access the Member Portal to check their claim status or contact us via the message center if the claim is not yet appearing. If additional assistance is needed, members can call the customer service number on the back of their member identification card. You will need to submit the following documentation, following the instructions below, to receive reimbursement for your over-the-counter test:. Note: If the Member Submitted Health Insurance Claim Form is incomplete or any of the required documentation noted above is not included with your reimbursement request your claim will be rejected with a rejection reason indicating that additional information is needed.
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WebYou must use a separate claim form for each patient. All expenses for one patient can be submitted with one claim form. 4. Mail completed claim form with all attached itemized . Oct 27, · On this page, you will find some recommended forms that providers may use when communicating with Highmark, its members or other providers in the network. Assignment of Major Medical Claim Form. Authorization for Behavioral Health Providers to Release Medical Information. Care Transition Care Plan. Discharge Notification Form. WebHighmark's mission is to be the leading health and wellness company in the communities we serve. Our vision is to ensure that all members of the community have access to .