July 1, 2022

Find Out If a Service Requires Prior Authorization

Review the latest Highmark Health Options Prior Authorization List. Updated quarterly, this document lists codes and prior authorization requirements for medical procedures and services. The contents of this document are subject to change in accordance with plan policies and procedures and the Provider Manual.

As a reminder, prior authorizations are required for:

•   All non-par providers.
•   Out-of-state providers.
•   All inpatient admissions, including organ transplants.
•   Durable medical equipment over $500.
•   Elective surgeries.
•   Any services that require coordination of benefits.
•   When the primary payer requires an authorization for the service.

Questions? Contact your provider account liaison or call Provider Services at 1-855-401-8251, Monday–Friday, 8 a.m. to 5 p.m.

May 11, 2022

Supporting Individuals with Substance Use Disorder

Highmark Health Options, in collaboration with Wayspring, has launched a data-driven Recovery Support Program that focuses exclusively on supplementing existing services, filling gaps in care, and meeting the complex physical, behavioral, and social needs of individuals with substance use disorder. This no-cost program is available for members and participating providers. Read the overview.

Dec. 17, 2021

Opioid-related Patient Risk Management

Highmark Blue Cross Blue Shield of Delaware and Highmark Health Options have collaborated with Wayspring, an independent company, to offer their axialHealthcare Risk Mitigation Solution to provide analytics and evidence-based support that may reduce opioid misuse. Read the overview.

Oct. 5, 2021

Evolve Emod for Minor Home Modification Services

Highmark Health Options is transitioning our minor home modification (MHM) benefit management service to Evolve Emod. As of Dec. 31, 2021, Evolve Emod’s all-inclusive benefit management solution will help enhance MHM processes for providers by streamlining:

•   Intake requests
•   Medical necessity review requests
•   Project close out reviews
•   Proposal reviews
•   Provider bid requests

This partnership will create a seamless continuation of service to Highmark Health Options LTSS members by providing safe and accessible MHM solutions.

Sept. 24, 2021

New Provider Portal Launching in 2022.

The new provider portal launches this winter, replacing NaviNet, the Enhanced Provider Portal, and parts of Highmark’s Provider Resource Center. Starting Oct. 22, 2021, authorization submissions will no longer be accepted through NaviNet. While the new provider portal is being developed, temporary manual processes will be in place for authorizations and appeals and claims disputes. Here's what to expect.

June 28, 2021

Philips Respironics Breathing Machines Recall

Highmark Health Options would like to make you aware of a voluntary recall issued by Philips Respironics for several of its breathing machines. Our goal is to keep you informed and ensure your patients receive the treatment they need. Get details about the recall.

June 7, 2021

EVV Update

DMMA has decided to discontinue their relationship with the EVV vendor. Therefore, EVV will not be going live on July 1, 2021. Read about the update.

May 20, 2021

Delaware SB 109 Reminder

In August 2020, Highmark Health Options shared a provider update regarding SB 109. The following serves as a reminder that, in cooperation with the State of Delaware, HHO continues to abide by SB 109, amending 18 Del.C. §§ 3343 and 3578 and 31 Del.C. §524, to increase access and decrease barriers to needed substance use disorder treatments.

Read the update

May 1, 2021

You're Invited: Virtual Provider Education and Demo

Join Highmark Health Options for a virtual info session on our quality program, pharmacy, provider network, and new risk adjustment platform. 

Date: Monday, May 17, 2021

Times: 11 a.m. to noon or 2 p.m. to 3 p.m.

Register for your session by emailing Provider Relations at Include your practice name, participant name(s), participant email address(es), and choice of session.

February 12, 2021

Coverage of COVID-19 Vaccine Administration

The Delaware Division of Medicaid and Medical Assistance (DMMA), in collaboration with the Delaware Division of Public Health (DPH), is working with federal, state and local stakeholders to implement Medicaid coverage of COVID-19 vaccines. 

Fore more information and frequently asked questions, refer to the DPH COVID-19 vaccine website or download the document.

February 2, 2021

Office-Based Opioid Treatment (OBOT) Fellowship

Delaware Health and Social Services (DHSS)'s Division of Medicaid and Medical Assistance (DMMA) is now enrolling clinicians in an expert-led, interactive, stipend-sponsored training to expand knowledge and skills for the treatment of opioid use disorder. Through self-paced modules, live discussions, and facilitated webinars, the training objectives for the program include: improving physical health outcomes for patients with opioid use disorders, facilitating easier treatment access, supporting overdose prevention and recovery, and more.

For more information and registration details, visit the OBOT homepage or download the flyer

January 20, 2021

Electronic Visit Verification New Start Date

The new Electronic Visit Verification (EVV) go-live date is July 1, 2021. As the system implementation moves forward, please continue with your efforts towards implementation. If you are using a third-party EVV system, please continue to collect EVV visit data. This will enable you to upload your visit data to the AuthentiCare aggregator when AuthentiCare is implemented.

DMMA will communicate additional updates going forward. For questions regarding EVV, email

December 30, 2020

Electronic Visit Verification Launch Postponed

The launch of Electronic Visit Verification (EVV) on Jan. 1, 2021, has been postponed.

Highmark Health Options will notify you of the new go-live date. While the overall system implementation will be delayed, please continue with your efforts towards implementation. If you are using a third-party EVV system, please move forward with collecting EVV data as of Jan. 1, 2021. This will enable you to upload your visit data to the AuthentiCare aggregator when AuthentiCare is implemented. If you are planning to use AuthentiCare as your EVV solution, it is not necessary for you to collect visit data during this delay. If you have received state-issued devices, please ensure they are safely stored.

Electronic Visit Verification (EVV) is an electronic system that records the time your personal care, nursing, and home health services begin and end. Highmark Health Options uses EVV as required by the federal government.

December 1, 2020

Highmark Health Options and eviCore Prior Authorization

Effective February 1, 2021, Highmark Health Options will require prior authorization from eviCore for the Medicaid membership delegated for cardiology and radiology services on dates of service February 1, 2021 and beyond.

View the PDF document

December 1, 2020

Billing for Home-Delivered Meals

The purpose of this information letter is to clarify the claim submission guidelines for Delaware Health Options Home-Delivered Meal Benefit.

View the PDF document

November 12, 2020

November Virtual Provider Forum

Highmark Health Options is committed to the safety of our employees, providers, and members. To continue our ongoing communication and education of our provider community, and will be hosting two virtual provider forums. 

View the PDF document 

November 12, 2020

Atlas Quarterly Outreach

The State of Delaware requires health plans to conduct a quarterly outreach to verify provider data. Beginning in April 2019, Highmark Health Options started conducting quarterly outreaches to verify your provider data and has continued every quarter to date. Our Vendor, Atlas Systems, Inc., performs the quarterly outreach on our behalf. 

View the PDF document 

October 9, 2020

Drive-Thru Food Pantry and Wellness Resources

On October 9, 2020 at 11am, the Department of Labor will be hosting a drive-thru food pantry. In addition, wellness resources will be available to all who attend. To find out more, view the PDF below. The location for this event has changed and will now be held at: Minquadale Fire Co., 129 E Hazeldell Ave, New Castle, DE 19720.

View the PDF document 

Billing for Home Delivered Meals


The purpose of this information letter is to clarify the claim submission guidelines for Delaware Health Options Home Delivered Meal Benefit.

Delaware Division of Medicaid and Medical Assistance Electronic Visit Verification (EVV) Provider Overview Training


The Division of Medical Medicaid & Medical Assistance has partnered with Fiserv in the implementation of Electronic Visit Verification (EVV) effective January 2021.

New Diabetes Prevention Program (DPP)


Highmark Health Options has partnered with the YMCA of Delaware to provide the Diabetes Prevention Program to our members.

Highmark Health Options’ New Healthy Weight Management Program


Highmark Health Options joined the Delaware Division of Medicaid and Medical Assistance (DMMA), as a founding member of the first ever collective national insurance initiative: My Healthy Weight; A pledge to provide obesity prevention and treatment for individuals of all age.

Providers Must Enroll to Prescribe for Medicaid Members


As required by the Patient Protection and Affordable Care Act (ACA) regulation 42 CFR §455.410, all practitioners, including those who order, refer or prescribe items or services for Medical Assistance beneficiaries, must be enrolled as participating providers with the Medical Assistance Program. Consistent with CMS and guidance from the Delaware Division of Medicaid and Medical Assistance (DMMA), it is imperative that ordering, referring or prescribing providers register with the Delaware Medical Assistance Program immediately in order to prevent any disruption in the fulfillment of your prescribed medications and medical services to our members after January 1, 2019. 

To enroll with DMMA, please visit: ProviderEnrollment/tabid/477/Default.aspx.