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Provider Resource Center
Updates and Notices
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Provider Resource Center
Updates and Notices
Updates and Notices
Read the latest faxes and communications to Highmark Health Options providers.
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Recent updates
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Provider Information Management Change effective March 1, 2025
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Prior Authorization Update for January 1
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DMMA Provider Forum: Medicaid Pediatric Dental Benefit Carve-In to Managed Care
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Changes to the Prior Authorization List
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Join us for the November Provider Forum
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Updated medical policy for enteral feeding in-line cartridge
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Authorizations and Care Plans through NaviNet
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Register for the joint MCO provider forum.
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Announcing the Specialty Split Fill Program.
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Earn CME/CEU With a Highmark Professional Education Webinar: Demystifying Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
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Medical policy for back-up ventilators in the home setting services.
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Register for the 2nd Joint MCO Provider Forum
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Reimbursement policy for Scanning Computerized Ophthalmic Diagnostic Imaging.
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Earn $100 for submitting the Obstetrical Needs Assessment Form.
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Join us for the September Provider Forum.
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Register for the Joint MCO Provider Forum
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Find training and continuing education with the HHO Provider Training Portal.
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Summer 2023 Provider Newsletter
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Better communication leads to better health care.
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Effective October 1, 2023: Updated Reimbursement Policies
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Reimbursement policy for chiropractic benefits and services.
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No cost in-home A1c and FIT test kits for eligible members.
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Join us for the August Provider Forum
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Electronically submit claims to HHO via NaviNet.
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Paper claims must be completely and correctly filled out to be processed.
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July Provider Forum Invite
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Specialty Pharmacy Management Update
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Effective July 29, 2023: Genetic testing services will require prior authorization.
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MDM Expansion Update July 2023
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Changes coming for school-based wellness center claims.
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ICD-10-CM Official Guidelines and Reporting Excludes Notes reimbursement policy.
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June Provider Forum Invite
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Spring 2023 Provider Newsletter
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Effective July 30, 2023, claims without the billing and rendering codes will be denied.
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Effective July 2, 2023: Updated Reimbursement Policies
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Effective June 18, 2023: Changes to the Prior Authorization List
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Effective June 15, 2023: Authorization requirements are no longer waived for COVID-19-related services
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May Provider Forum Invite
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Effective May 1, 2023: Updated PA and APRN reimbursement policy
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Patients may lose Medicaid. Here are ways you can help during the renewal process.
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Effective June 1, 2023: Quarterly Medical Policy Changes
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NARCAN Highmark Health Options Formulary Announcement
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Effective May 17, 2023: Therapy Services reimbursement policy update
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Effective May 10, 2023: Ambulance, Clinical Trials, and Dialysis reimbursement policy updates
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April Provider Forum Invite
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Effective May 4, 2023: Changes to the Prior Authorization List
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Effective May 3, 2023: Colorectal cancer screening policy update
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Access immunization records through the Immunization Registry, part of the Delaware Immunization Program
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Reminder: Members should not be balance billed by any participating provider
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Effective April 22, reimbursement policy for chiropractic services
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March Provider Forum Invite
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Bill Continuous Glucose Monitoring (CGM) systems through the Pharmacy benefit.
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Effective Apr. 3, Updated Quarterly Medical Policy Changes.
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Winter 2023 Provider Newsletter
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Effective Apr. 3, Updated Reimbursement Policies
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Use participating providers for genetic testing requests.
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Changes to the Prior Authorization List
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Review the payment policies for Federally Qualified Health Centers (FQHC) claims
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Feb. Provider Forum Hosted by Clinical Quality
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New Pediatric Respite Benefits
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Alert: Norditropin® Drug Shortage
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Effective Jan. 20, 2023, check and EFT payments will occur weekly
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Effective Jan. 1, 2023, New Medical Record Standard: Document Member Consent for Virtual Visits
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Join us for a Virtual Provider Lunch and Learn Hosted by Pharmacy Services
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Effective Jan. 1, 2023, New Timely Access Standard for Behavioral Health Providers
2022
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Dec 2022 EVV program launch announcement
Dec 2022 EVV trainings
Dec 2022 EVV important contact informtation
Dec 2022 MDM Expansion
Dec 2022 Reminder: Claims received without the primary adjudication date will be denied
Dec 2022 Effective Jan. 20, 2023, check and EFT payments will occur weekly
Nov 2022 December Provider Forum Invite
Nov 2022 Maternal Opioid Use Disorder (MOUD) Referral Incentive Program
Nov 2022 Botox Provider Update
Oct 2022 Effective Nov. 15, 2022: Use updated billing codes on upper gastrointestinal endoscopy claims
Oct 2022 Effective Oct. 28, 2022: eviCore platform updates
Oct 2022 Omnipod products added to the pharmacy benefit
Oct 2022 MDM Expansion Update
Sept 2022 Provider Satisfaction Survey Notification
Sept 2022 In-Home a1c Testing Kits for Eligible Members
Aug 2022 DHSS Direct Support Professionals’ Recruitment and Retention Payments MCO Provider Training
Aug 2022 DHSS Direct Support Professionals (DSP) Recruitment and Retention Payments – Frequently Asked Questions
Aug 2022 Annual Quality Reporting for Member Medical Record Data
Aug 2022 Reimbursement Policy for Home-Delivered Meals
Aug 2022 Clinical Quality Feedback Loop Update
July 2022 Effective Sept. 16, 2022: eviCore Platform Updates
July 2022 CPT Code Changes
July 2022 Prior Authorization List Notification
June 2022 Effective Aug. 29, 2022: Prior Authorization Required for Radiation Therapy
June 2022 Diagnosis Code Change for Outpatient Emergency Room Facility (UB) Claims
June 2022 Nurtec ODT Prior Authorization Required
May 2022 Effective July 15, 2022: Updated MDM Expansion – Prior Authorization Required
May 2022 CGRP Antagonists Prior Authorization Required
May 2022 WaySpring Substane Use Disorder
Apr 2022 EVV Provider Survey
Mar 2022 Effective May 1, 2022: Obtain Member Consent Before Filing Appeals on Their Behalf
Mar 2022 Recall: New Credentialing Requirements for Organizational Providers
Mar 2022 Effective Mar. 15, 2022: MDM Expansion – Prior Authorization Required
Jan 2022 Effective Mar. 1, 2022: Methadone Reimbursement to Increase
Jan 2022 Mandatory Provider Enrollment for All HHO Providers Servicing Delaware Medicaid
2021
Open
Nov 2021 LTSS Service Authorizations Extension
Nov 2021 Billing Change for DME NOC and Miscellaneous Codes
Nov 2021 Shared Health Migrated to Highmark Health Options Support Center
Nov 2021 Pharmacy and Durable Medical Equipment (DME) Guidelines
Nov 2021 MDM Expansion: Prior Authorization Required Effective January 1, 2022
Sept 2021 New Provider Portal and Temporary Manual Process for Authorization Submissions
Sept 2021 Musculoskeletal Provider Orientation Session
Sept 2021 Prior Authorization Required from eviCore Healthcare for Musculoskeletal Services Only Effective Nov. 1, 2021
July 2021 July Provider Forum Invitation
July 2021 MDM Expansion – Prior Authorization Required Effective Sept. 1, 2021
June 2021 MDM Expansion: Prior Authorization Required for Myobloc and Xeomin
June 2021 Reminder: LabCorp is the Preferred Provider for Outpatient Laboratory Testing
May 2021 Provider Forum
Apr 2021 Billing Change for Durable Medical Equipment Not Otherwise Classified (DME NOC) and Miscellaneous Codes
Apr 2021 Risk Adjustment Provider Education and Demonstration Invitation
Apr 2021 Professionals-Submitting a Corrected Claim Fax
Apr 2021 Facility-Submitting a Corrected Claim Fax
Feb 2021 MDM Expansion Notification
Feb 2021 Medical Coverage of COVID-19 Vaccine Administration | Info & FAQs
Feb 2021 Claims Disputes
Feb 2021 New EVV Go-Live Date is July 1, 2021
Jan 2021 Provider Orientation Sessions for Radiology and Cardiology Prior Authorizations
Jan 2021 Biosimilar Step Requirement
2020
Open
October 2020: Reminder Specific Medications Require Prior Authorization
October 2020 DMMA Electronic Visit Verification Survey for Community Based Services, Home Health and Personal Care Service Providers
July 2020 HHO Outpatient Claims EOB Submission
June 2020 June Virtual Provider Forum Invitation
June 2020 Resubmitting a Claim with a New EOB
June 2020 Appeals and Grievances Department – July 5 Contact Changes
May 2020 Commercial Insurance Disallowance Process
May 2020 Billing for Home Delivered Meals
Apr 2020 ICD-10-CM Official Guidelines for Coding and Reporting: Excludes Notes
Mar 2020 COVID-19 Telehealth Policy Update
Mar 2020 COVID-19 Updates and Information
Feb 2020 Billing for Home Delivered Meals
Feb 2020 DPH Information on Monitoring Returning Travelers for Coronavirus
Jan 2020 2020 CPT Codes and Updates
2019
Open
Nov 2019 CARE COORDINATORS AND LTSS CASE MANAGERS – TEMPORARILY NOT ACCEPTING DIRECT FAXES
Oct 2019 JOIN US TO DISCUSS EARLY PERIODIC SCREENING DIAGNOSIS AND TREATMENT (EPSDT) 10/23 OR 10/24
Sept 2019 YOU’RE INVITED TO OUR PROVIDER FORUMS
Sept 2019 2019 PROVIDER SATISFACTION SURVEY BEGINS IN SEPTEMBER
Aug 2019 MEDICAL POLICIES EFFECTIVE SEPT 16, 2019
Jul 2019 MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE November 4, 2019
Jul 2019 RETRO REVIEW PROCESS CHANGE
Jul 2019 TAXONOMY REQUIRED ON CLAIMS SUBMISSIONS
Jun 2019 ATLAS QUARTERLY OUTREACH
June 2019 NEW REMITTANCE ADVICES ADDRESS OFFSETS
May 2019 MEDICAL POLICIES EFFECTIVE JUNE 3, 2019
Apr 2019 NOTICE OF REVISED MEDICAL POLICIES EFFECTIVE May 6, 2019
Mar 2019 MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE JUNE 3, 2019
Jan 2019 Change in Authorization Process for Home and Community Based (HCBS) Providers
Jan 2019 BILATERAL PROCEDURES
Jan 2019 NOTICE OF REVISED MEDICAL POLICIES EFFECTIVE FEB 15
Jan 2019 DE MEDICAID RETROSPECTIVE RISK GAP CLOSURE CAMPAIGN WILL LAUNCH JAN. 2, 2019
Jan 2019 NEW PERMANENT PROCEDURE CODE ASSIGNED, EFFECTIVE JAN 1, 2019
2018
Open
Oct 2018 NOTICE OF REVISED MEDICAL POLICIES EFFECTIVE Nov 15
Sept 2018 PROVIDER FORUM INVITATION
Sept 2018 MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE DEC 3, 2018
Aug 2018 MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE OCT 1, 2018
July 2018 NOTICE OF REVISED AND NEW DRUG & MEDICAL POLICIES EFFECTIVE AUG 15
June 2018 LabCorp is Preferred Provider for Outpatient Laboratory Testing
June 2018 MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE SEPT 3, 2018
May 2018 SELF AUDITS/OVERPAYMENTS
Apr 2018 NOTICE OF REVISED AND NEW DRUG & MEDICAL POLICIES EFFECTIVE MAY 15
Mar 2018 Recognizing and Reporting Quality of Care and Quality of Service Concerns
Feb 2018 2017 Provider Survey Results
Feb 2018 PROVIDER FORUM INVITATION
Jan 2018 SUBSTANCE ABUSE TREATMENT PRIOR AUTHORIZATION PROCEDURE CHANGE
Jan 2018 NOTICE OF REVISED AND NEW DRUG & MEDICAL POLICIES EFFECTIVE FEB 15
Jan 2018 PROVIDER EDUCATION WEBINARS: NEW EHS OPERATING SYSTEM
Jan 2018 NOTICE OF PRIOR AUTHORIZATION CODES REMOVAL EFFECTIVE FEB. 15
Jan 2018 MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE MARCH 5TH, 2018 (REVISED)
2017
Open
Dec 2017 LTSS PROVIDER AUTHORIZATION UPDATE
Dec 2017 NEW OPERATING PLATFORM (EHS) TO GO LIVE JAN 1
Dec 2017 IMPORTANT CHANGES RELATED TO NEW OPERATING PLATFORM TRANSITION
Nov 2017 MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE JANUARY 8TH, 2018
Oct 2017 MY DIABETES REPORT CARD
Aug 2017 EPSDT REPORTS ARE NOW AVAILABLE ON NAVINET
Aug 2017 YOU’RE INVITED TO OUR PROVIDER FORUMS (8/14, 8/15 and 8/16)
Aug 2017 NOTICE OF REVISED AND NEW DRUG & MEDICAL POLICIES EFFECTIVE SEPT. 1
June 2017 YOU’RE INVITED TO OUR PROVIDER FORUMS
Feb 2017 PROVIDER PLAN OF CARE PROCESS ENHANCED
Jan 2017 HIGHMARK HEALTH OPTIONS LAUNCHES COMMUNITY REPOSITORY
Jan 2017 PCPS: WATCH YOUR MAIL FOR NEW PHYSICIAN PORTFOLIO
2016
Open
Sept 2016 New Phone Number for Providers
Sept 2016 New Reimbursement Rates for Lucentis and Eylea, effective Sept. 1
Sept 2016 Highmark Health Options Provider Forums
Sept 2016 Enhanced Clinical Editing Process - Eight New Drug Policies Aim to Promote Correct Coding
Sept 2016 Report Critical Incidents Within Two Business Days
Sept 2016 Reminder: Attend a Highmark Health Options Provider Forum
Aug 2016 Please Complete & Return Important Risk-Gap Closure Forms
Aug 2016 Reminder to Track Missed Home Care Visits
July 2016 New Fax Number for Claim Appeals And Correction from Previous Bulletin
June 2016 Readmissions and Retrospective Authorizations
June 2016 Adjustments to Reimbursement Rates/Billing Codes for Institutions for Mental Disease (IMDs)
June 2016 State Revisions and Updates to the Comprehensive Medical Report B (Map B) Form
June 2016 Adjustments to IUD Reimbursement Rates
June 2016 Readmissions and Retrospective Authorizations
June 2016 Enhanced Clinical Editing Processes
May 2016 New Fax Numbers Available for Submitting Auths (Medicaid)
May 2016 My Diabetes Report Card Mailing
Apr 2016 Adjustments to Reimbursement Rates
Feb 2016 Fluoride Varnish - The Physician's Role in Children's Oral Health
Feb 2016 Provider Forums - LTSS Focus
Jan 2016 Adjustments to Reimbursement Rates
Jan 2016 Enhanced Clinical Editing Processes
Jan 2016 Oral Care
2015
Open
Oct 2015 Enhanced Clinical Editing Processes
July 2015 Authorization Update - for LTSS Providers
July 2015 Early Periodic Screening Diagnosis and Treatment (EPSDT) Program
July 2015 ICD-10 Compliance Date Quickly Approaching
July 2015 ICD-10 Reminder and New Appeals and Grievance Address
June 2015 Vaccine Billing Procedure Differs for Children and Adults (clarification)
June 2015 Long-Term Services and Supports to Require Authorization, effective June 15
May 2015 Provider Relations Representative Territory Changes
April 2015 Update on NaviNet Access
Mar 2015 EFT and ERA
Mar 2015 Long-Term Support Services (LTSS) Authorization Update
Feb 2015 Behavioral Health Services
Feb 2015 Claim Submission Reminders
Feb 2015 Authorization Requirements for Health Options Members are in Place
Feb 2015 NIA Programs
Feb 2015 Vaccine Reimbursements
Feb 2015 Provider Forums
Jan 2015 Frequently Asked Questions
Jan 2015 Submitting Authorization Requests
Jan 2015 Physical and Occupational Therapy Daily Maximum Increased
Jan 2015 PCP Assignments and Outpatient Lab Services
Jan 2015 Member ID Cards and PCP Assignments
Jan 2015 Formulary and Pharmacy Update
2014
Open
Dec 2014 PROVIDER MANUAL NOW ONLINE
Dec 2014 PROVIDER MANUAL UPDATED
Dec 2014 FREQUENTLY ASKED QUESTIONS
Dec 2014 CONTINUITY OF CARE AND AUTHORIZATION REQUESTS
Dec 2014 RADIOLOGY MANAGEMENT PROGRAM BEGINS FEB. 1, 2015
Nov 2014 Health Options Workshop
Nov 2014 Corrections to the Health Options Workshop
Oct 2014 Fee Schedule Update
Oct 2014 Medicaid Program Update
Sept 2014 Medicaid Program Update
