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  2. Providers
  3. Updates and Notices

Updates and Notices

picture_as_pdfMDM Expansion: Prior Authorization Required Effective July 15, 2022
picture_as_pdfEVV Provider Survey
picture_as_pdfRecall: New Credentialing Requirements for Organizational Providers
picture_as_pdfUpdated Claims and Billing Guidelines for FQHC (Effective Mar. 4, 2022)
picture_as_pdfMethadone Reimbursement to Increase Effective March 1, 2022
picture_as_pdfMDM Expansion: Prior Authorization Required Effective March 15, 2022
picture_as_pdfMandatory Provider Enrollment for All HHO Providers Servicing Delaware Medicaid
picture_as_pdfLTSS Service Authorizations Extension
picture_as_pdfBilling Change for DME NOC and Miscellaneous Codes
picture_as_pdfShared Health Migrated to Highmark Health Options Support Center
picture_as_pdfPharmacy and Durable Medical Equipment (DME) Guidelines (Updated Nov. 10, 2021)
picture_as_pdfMDM Expansion: Prior Authorization Required Effective January 1, 2022
picture_as_pdfNew Provider Portal and Temporary Manual Process for Authorization Submissions
picture_as_pdfMSK Provider Orientation Session Invite
picture_as_pdfPrior Authorization Required from eviCore Healthcare for Musculoskeletal Services Only Starting Nov. 1, 2021
picture_as_pdfJuly Provider Forum Invitation
picture_as_pdfMDM Expansion: Prior Authorization Required Effective September 1
picture_as_pdfMDM Expansion: Prior Authorization Required for Myobloc and Xeomin
picture_as_pdfMay 2021 Provider Forum
picture_as_pdfReminder: LabCorp is the Preferred Provider for Outpatient Laboratory Testing
picture_as_pdfBilling Change for Durable Medical Equipment Not Otherwise Classified (DME NOC) and Miscellaneous Codes
picture_as_pdfRisk Adjustment Provider Education and Demonstration Invitation
picture_as_pdfProfessionals-Submitting a Corrected Claim Fax
picture_as_pdfFacility-Submitting a Corrected Claim Fax
picture_as_pdfMDM Expansion Notification
picture_as_pdfMedical Coverage of COVID-19 Vaccine Administration | Info & FAQs
picture_as_pdfClaims Disputes
picture_as_pdfNew EVV Go-Live Date is July 1, 2021
picture_as_pdfProvider Orientation Sessions for Radiology and Cardiology Prior Authorizations
picture_as_pdfBiosimilar Step Requirement
picture_as_pdfOctober 2020: Reminder Specific Medications Require Prior Authorization
picture_as_pdfOctober 2020 DMMA Electronic Visit Verification Survey for Community Based Services, Home Health and Personal Care Service Providers
picture_as_pdfHHO Outpatient Claims EOB Submission
picture_as_pdfSept 2014 MEDICAID PROGRAM UPDATE
picture_as_pdfOct 2014 FEE SCHEDULE UPDATE
picture_as_pdfOct 2014 MEDICAID PROGRAM UPDATE
picture_as_pdfNov 2014 HEALTH OPTIONS WORKSHOP
picture_as_pdfNov 2014 CORRECTIONS TO THE HEALTH OPTIONS WORKSHOP
picture_as_pdfDec 2014 PROVIDER MANUAL NOW ONLINE
picture_as_pdfDec 2014 PROVIDER MANUAL UPDATED
picture_as_pdfDec 2014 FREQUENTLY ASKED QUESTIONS
picture_as_pdfDec 2014 CONTINUITY OF CARE AND AUTHORIZATION REQUESTS
picture_as_pdfDec 2014 RADIOLOGY MANAGEMENT PROGRAM BEGINS FEB. 1, 2015
picture_as_pdfJan 2015 FREQUENTLY ASKED QUESTIONS
picture_as_pdfJan 2015 SUBMITTING AUTHORIZATION REQUESTS
picture_as_pdfJan 2015 PHYSICAL & OCCUPATIONAL THERAPY DAILY MAXIMUM INCREASED
picture_as_pdfJan 2015 PCP ASSIGNMENTS AND OUTPATIENT LAB SERVICES
picture_as_pdfJan 2015 MEMBER ID CARDS AND PCP ASSIGNMENTS
picture_as_pdfJan 2015 FORMULARY AND PHARMACY UPDATE
picture_as_pdfFeb 2015 BEHAVIORAL HEALTH SERVICES
picture_as_pdfFeb 2015 CLAIM SUBMISSION REMINDERS
picture_as_pdfFeb 2015 AUTHORIZATION REQUIREMENTS FOR HEALTH OPTIONS MEMBERS ARE IN PLACE
picture_as_pdfFeb 2015 NIA PROGRAMS
picture_as_pdfFeb 2015 VACCINE REIMBURSEMENTS
picture_as_pdfFeb 2015 PROVIDER FORUMS
picture_as_pdfMar 2015 EFT AND ERA
picture_as_pdfMar 2015 LONG-TERM SUPPORT SERVICES (LTSS) AUTHORIZATION UPDATE
picture_as_pdfApril 2015 UPDATE ON NAVINET ACCESS
picture_as_pdfMay 2015 PROVIDER RELATIONS REPRESENTATIVE TERRITORY CHANGES
picture_as_pdfJune 2015 LONG TERM SERVICES AND SUPPORTS TO REQUIRE AUTHORIZATION, EFFECTIVE JUNE 15, 2015
picture_as_pdfJune 2015 VACCINE BILLING PROCEDURE DIFFERS FOR CHILDREN AND ADULTS (CLARIFICATION)
picture_as_pdfJuly 2015 AUTHORIZATION UPDATE - FOR LTSS PROVIDERS
picture_as_pdfJuly 2015 EARLY PERIODIC SCREENING DIAGNOSIS AND TREATMENT (EPSDT) PROGRAM
picture_as_pdfJuly 2015 ICD-10 COMPLIANCE DATE QUICKLY APPROACHING
picture_as_pdfJuly 2015 ICD-10 REMINDER AND NEW APPEALS AND GRIEVANCE ADDRESS
picture_as_pdfOct 2015 ENHANCED CLINICAL EDITING PROCESSES
picture_as_pdfJan 2016 ADJUSTMENTS TO REIMBURSEMENT RATES
picture_as_pdfJan 2016 ENHANCED CLINICAL EDITING PROCESSES
picture_as_pdfJan 2016 ORAL CARE
picture_as_pdfFeb 2016 FLUORIDE VARNISH — THE PHYSICIAN'S ROLE IN CHILDREN’S ORAL HEALTH
picture_as_pdfFeb 2016 PROVIDER FORUMS – LTSS FOCUS
picture_as_pdfApr 2016 ADJUSTMENTS TO REIMBURSEMENT RATES
picture_as_pdfMay 2016 NEW FAX NUMBERS AVAILABLE FOR SUBMITTING AUTHS (MEDICAID)
picture_as_pdfMay 2016 MY DIABETES REPORT CARD MAILING
picture_as_pdfJune 2016 READMISSIONS AND RETROSPECTIVE AUTHORIZATIONS
picture_as_pdfJune 2016 ADJUSTMENTS TO REIMBURSEMENT RATES/BILLING CODES FOR INSTITUTIONS FOR MENTAL DISEASE (IMDs)
picture_as_pdfJune 2016 STATE REVISIONS AND UPDATES TO THE COMPREHENSIVE MEDICAL REPORT B (MAP B) FORM
picture_as_pdfJune 2016 ADJUSTMENTS TO IUD REIMBURSEMENT RATES
picture_as_pdfJune 2016 READMISSIONS AND RETROSPECTIVE AUTHORIZATIONS
picture_as_pdfJune 2016 ENHANCED CLINICAL EDITING PROCESSES
picture_as_pdfJuly 2016 New Fax Number for Claim Appeals and Correction From Previous Bulletin
picture_as_pdfAug 2016 PLEASE COMPLETE & RETURN IMPORTANT RISK-GAP CLOSURE FORMS
picture_as_pdfAug 2016 REMINDER TO TRACK MISSED HOME CARE VISITS
picture_as_pdfSept 2016 NEW PHONE NUMBER FOR PROVIDERS
picture_as_pdfSept 2016 NEW REIMBURSEMENT RATES FOR LUCENTIS AND EYLEA, EFFECTIVE SEPT. 1
picture_as_pdfSept 2016 HIGHMARK HEALTH OPTIONS PROVIDER FORUMS
picture_as_pdfSept 2016 ENHANCED CLINICAL EDITING PROCESS — EIGHT NEW DRUG POLICIES AIM TO PROMOTE CORRECT CODING
picture_as_pdfSept 2016 REPORT CRITICAL INCIDENTS WITHIN TWO BUSINESS DAYS
picture_as_pdfSept 2016 REMINDER: ATTEND A HIGHMARK HEALTH OPTIONS PROVIDER FORUM
picture_as_pdfJan 2017 PCPS: WATCH YOUR MAIL FOR NEW PHYSICIAN PORTFOLIO
picture_as_pdfJan 2017 HIGHMARK HEALTH OPTIONS LAUNCHES COMMUNITY REPOSITORY
picture_as_pdfFeb 2017 PROVIDER PLAN OF CARE PROCESS ENHANCED
picture_as_pdfJune 2017 YOU’RE INVITED TO OUR PROVIDER FORUMS
picture_as_pdfJuly 2017 INTRODUCTION LETTER TO THE OPERATIONAL CHANGES EFFECTIVE SEPT 2017
picture_as_pdfAug 2017 NOTICE OF REVISED AND NEW DRUG & MEDICAL POLICIES EFFECTIVE SEPT. 1
picture_as_pdfAug 2017 YOU’RE INVITED TO OUR PROVIDER FORUMS (8/14, 8/15 and 8/16)
picture_as_pdfAug 2017 EPSDT REPORTS ARE NOW AVAILABLE ON NAVINET
picture_as_pdfOct 2017 NOTICE OF REVISED AND NEW DRUG & MEDICAL POLICIES EFFECTIVE NOV 1
picture_as_pdfOct 2017 MY DIABETES REPORT CARD
picture_as_pdfNov 2017 MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE JANUARY 8TH, 2018
picture_as_pdfDec 2017 LTSS PROVIDER AUTHORIZATION UPDATE
picture_as_pdfDec 2017 NEW OPERATING PLATFORM (EHS) TO GO LIVE JAN 1
picture_as_pdfDec 2017 IMPORTANT CHANGES RELATED TO NEW OPERATING PLATFORM TRANSITION
picture_as_pdfJan 2018 NOTICE OF REVISED AND NEW DRUG & MEDICAL POLICIES EFFECTIVE FEB 15
picture_as_pdfJan 2018 PROVIDER EDUCATION WEBINARS: NEW EHS OPERATING SYSTEM
picture_as_pdfJan 2018 NOTICE OF PRIOR AUTHORIZATION CODES REMOVAL EFFECTIVE FEB. 15
picture_as_pdfJan 2018 MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE MARCH 5TH, 2018 (REVISED)
picture_as_pdfJan 2018 SUBSTANCE ABUSE TREATMENT PRIOR AUTHORIZATION PROCEDURE CHANGE
picture_as_pdfFeb 2018 PROVIDER FORUM INVITATION
picture_as_pdfFeb 2018 2017 Provider Survey Results
picture_as_pdfMar 2018 Recognizing and Reporting Quality of Care and Quality of Service Concerns
picture_as_pdfApr 2018 NOTICE OF REVISED AND NEW DRUG & MEDICAL POLICIES EFFECTIVE MAY 15
picture_as_pdfMay 2018 SELF AUDITS/OVERPAYMENTS
picture_as_pdfJune 2018 MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE SEPT 3, 2018
picture_as_pdfJune 2018 LabCorp is Preferred Provider for Outpatient Laboratory Testing
picture_as_pdfJuly 2018 NOTICE OF REVISED AND NEW DRUG & MEDICAL POLICIES EFFECTIVE AUG 15
picture_as_pdfAug 2018 MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE OCT 1, 2018
picture_as_pdfSept 2018 MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE DEC 3, 2018
picture_as_pdfSept 2018 PROVIDER FORUM INVITATION
picture_as_pdfOct 2018 NOTICE OF REVISED MEDICAL POLICIES EFFECTIVE Nov 15
picture_as_pdfJan 2019 NEW PERMANENT PROCEDURE CODE ASSIGNED, EFFECTIVE JAN 1, 2019
picture_as_pdfJan 2019 DE MEDICAID RETROSPECTIVE RISK GAP CLOSURE CAMPAIGN WILL LAUNCH JAN. 2, 2019
picture_as_pdfJan 2019 NOTICE OF REVISED MEDICAL POLICIES EFFECTIVE FEB 15
picture_as_pdfJan 2019 BILATERAL PROCEDURES
picture_as_pdfJan 2019 Change in Authorization Process for Home and Community Based (HCBS) Providers
picture_as_pdfMar 2019 MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE JUNE 3, 2019
picture_as_pdfApr 2019 NOTICE OF REVISED MEDICAL POLICIES EFFECTIVE May 6, 2019
picture_as_pdfMay 2019 MEDICAL POLICIES EFFECTIVE JUNE 3, 2019
picture_as_pdfJune 2019 NEW REMITTANCE ADVICES ADDRESS OFFSETS
picture_as_pdfJun 2019 ATLAS QUARTERLY OUTREACH
picture_as_pdfJul 2019 TAXONOMY REQUIRED ON CLAIMS SUBMISSIONS
picture_as_pdfJul 2019 RETRO REVIEW PROCESS CHANGE
picture_as_pdfJul 2019 MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE November 4, 2019
picture_as_pdfAug 2019 MEDICAL POLICIES EFFECTIVE SEPT 16, 2019
picture_as_pdfSept 2019 2019 PROVIDER SATISFACTION SURVEY BEGINS IN SEPTEMBER
picture_as_pdfSept 2019 YOU’RE INVITED TO OUR PROVIDER FORUMS
picture_as_pdfOct 2019 MEDICAL POLICIES EFFECTIVE NOV 4, 2019
picture_as_pdfOct 2019 JOIN US TO DISCUSS EARLY PERIODIC SCREENING DIAGNOSIS AND TREATMENT (EPSDT) 10/23 OR 10/24
picture_as_pdfNov 2019 CARE COORDINATORS AND LTSS CASE MANAGERS – TEMPORARILY NOT ACCEPTING DIRECT FAXES
picture_as_pdfJune 2020 June Virtual Provider Forum Invitation
picture_as_pdfJune 2020 Resubmitting a Claim with a New EOB
picture_as_pdfJune 2020 Appeals and Grievances Department – July 5 Contact Changes
picture_as_pdfJune 2020 Submitting Correct Indicator When Medicare Advantage Plan is the Primary Payer
picture_as_pdfMay 2020 Commercial Insurance Disallowance Process
picture_as_pdfMay 2020 Billing for Home Delivered Meals
picture_as_pdfApr 2020 ICD-10-CM Official Guidelines for Coding and Reporting: Excludes Notes
picture_as_pdfMar 2020 COVID-19 Telehealth Policy Update
picture_as_pdfMar 2020 COVID-19 Updates and Information
picture_as_pdfFeb 2020 Billing for Home Delivered Meals
picture_as_pdfFeb 2020 DPH Information on Monitoring Returning Travelers for Coronavirus
picture_as_pdfJan 2020 2020 CPT Codes and Updates