WebAuthorization Requirements Your insurance coverage may require authorization of certain services, procedures, and/or DMEPOS prior to performing the procedure or service. The … WebDuring the year, Highmark makes several adjustments to the full list of outpatient procedures, services, durable medical equipment, and drugs requiring authorization. For benefits to be paid, the member must be eligible on the date of service and the service must be a covered benefit.

Authorization Requirements - Highmark

WebProviders in need of assistance should contact provider services at 800-241-5704 (toll-free). Reporting Fraud. Do not use this mailing address or form to report fraud. If you suspect … WebHighmark Wholecare Pharmacy Division Phone 800-392-1147 Fax 888-245-2049 . Requirements for Prior Authorization of Antipsychotics. A. Prescriptions That Require … slow motion songs

Highmark Wholecare Medical Specialty Solutions Quick …

WebFindhelp is a separate company that gathers community based organization resources for Highmark Wholecare. Health benefits or health benefit administration may be provided by or through Highmark Wholecare, coverage by Gateway Health Plan, an independent licensee of the Blue Cross Blue Shield Association (“Highmark Wholecare”). WebRequest for Extension of Authorization End Date: 10 Days 20 Days 30 Days To request an extension of the treatment timeframe (end date) on visits previously authorized but not yet utilized. Please Note: One (1) date extension will be considered per episode of care with a maximum of thirty (30) days. Request WebUpdated: 12/2024 PARP Approved: 12/2024 Gateway Health Prior Authorization Criteria Stimulant Medications (ADHD and Narcolepsy) All requests for Stimulant Medications for members under the age of 4 or 21 years of age and older require a prior authorization and will be screened for medical necessity and appropriateness using the criteria listed below. slow motion sony camera