Does Highmark require prior authorization?

Does Highmark require prior authorization?

Highmark now requires authorization numbers to ensure appropriate reimbursement. reimbursement. Denials of coverage of services may be issued based on medical necessity and/or appropriateness determinations.

Is Highmark the same as Highmark Blue Shield?

About Highmark Inc. Highmark is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. For more information, visit

What is Highmark performance blue?

Known as Performance Blue and Performance Flex Blue, the high-performing networks are focused on delivering quality care and lowering cost through strong relationships with local providers such as, but not limited to, Allegheny Health Network, Conemaugh Health System, Excela Health System, Washington Health System, St …

Which brand can be used for Blue branded activities and functions in the western and northeastern Pennsylvania region?

Highmark Inc.
About Highmark Inc. and its Blue-branded affiliates proudly cover the insurance needs of more than 6 million members in Pennsylvania, Delaware and West Virginia, along with Western and Northeastern New York.

Does Highmark use eviCore?

Effective Jan. 1, 2019, eviCore will manage advanced imaging and cardiology services for Highmark Delaware members.

Does Highmark use NaviNet?

NaviNet gives users real-time access to Highmark’s membership, claims and provider and payment systems, making your job easier.

Is Highmark same as Blue Cross?

“In the coming months, the newly affiliated organization will be rebranded Highmark Blue Cross Blue Shield of Western New York and Highmark Blue Shield of Northeastern New York,” the two Blue Cross plans said. Financial terms of the deal weren’t disclosed.

What does high performance provider mean?

Providers in a true high-performance network consistently deliver both lower costs and higher quality through care that is patient-centered, evidence-based, appropriate and coordinated.

What is a high performance network?

High-performance networks (HPNs) are not just narrow networks. • HPNs focus on delivering high-quality, efficient care, generally resulting in lower total costs for health programs. • Actuaries are key in supporting the needs of both the development and the ongoing work of HPNs.

What is the difference between Blue Shield and Blue Cross?

Blue Cross and Blue Shield developed separately, with Blue Cross providing coverage for hospital services and Blue Shield covering physicians’ services. Blue Cross is a name used by an association of health insurance plans throughout the United States.

What is Evicore phone number?

You can also email us at [email protected], or reach us by phone at 800-646-0418, option 2.

What is the purpose of NaviNet?

NaviNet is America’s leading healthcare provider portal connecting over 40 health plans and 60% of the nation’s physicians. It is an easy-to-use, free, web-based solution linking providers to Keystone First VIP Choice. Through NaviNet, you can access, submit, or verify: Eligibility information.

What payers are on NaviNet?

“NaviNet has a tremendous, long-term customer base of more than 40 health plans – Blue Cross Blue Shield payers, Aetna, Cigna, and many others – a nationwide network of more than 450,000 active end-users across all 50 states, and an All-Payer Access provider portal to 450+ commercial and government plans nationally …

What kind of company is Highmark?

Description: Highmark Health is the parent company of a national health and wellness enterprise that employs more than 35,000 people and serves 40 million Americans in all 50 states. The Highmark Health enterprise is the third largest integrated health care delivery and financing system in the nation.

What plans are under Highmark?

Highmark Health Plans

  • Highmark Inc.
  • Highmark Blue Shield.
  • Highmark Blue Cross Blue Shield.
  • Highmark Blue Cross Blue Shield Delaware.
  • Highmark Blue Cross Blue Shield West Virginia.
  • Highmark Blue Cross Blue Shield of Western New York.
  • Highmark Blue Cross Blue Shield of Northeasteren New York.

What is high performance mean?

Definition of high performance : better, faster, or more efficient than others high performance cars/airplanes/boats high performance running shoes.

What is a high performing workplace?

Gartner defines a high performance workplace as a physical or virtual environment designed to make workers as effective as possible in supporting business goals and providing value.

What is the difference between HPN and PPO?

An exclusive provider organization (EPO) with an HPN is similar to a PPO except that it only employs one tier. Providers and facilities in the HPN are covered by the insurer with limited member cost sharing. If a member uses a provider or facility outside of the network, they must pay the full cost of the service.