ACTION REQUIRED!

Comply with the 21st Century Cures Act by registering NPI(s), taxonomies, and service location(s) with Delaware Medical Assistance Portal (DMAP) by Sept. 30, 2023. Failure to enroll with DMAP before this deadline will lead to denied claims with no option for reprocessing and potential termination from network participation. Enroll now!

Provider Manual and Resources

Resources

Find out if a service requires Prior Authorization

Use the online Prior Authorization Code Lookup and search by codes or review the latest Highmark Health Options Prior Authorization List. Updated regularly, this document lists codes and prior authorization requirements for medical procedures and services. The contents of this list are subject to change in accordance with plan policies and procedures and the Provider Manual.

Highmark Health Options Community Support

Find help for your patients based on unique needs and location. The free, anonymous search feature can help you and your patients find care, education, food, housing, legal, money, work, and more. Start searching for resources by visiting Community Support and entering a ZIP code. Find help today.

Pharmacy Prior Authorization with CoverMyMeds

CoverMyMeds helps patients get the medication they need to live healthy lives by streamlining the prior authorization (PA) process for providers and pharmacists. Start today by creating a free account, or logging in to your existing account at CoverMyMeds.com.

Prior Authorization with eviCore

Highmark Health Options requires prior authorization from eviCore for cardiology and radiology services. Refer to the Prior Authorization List for details or visit eviCore.

Provider Contracts

Fee Schedule and Procedure Codes

Standard Rates for medical specialty drugs and injections are reimbursed at the Average Sale Price (“ASP”) minus 6%. For more information, call Provider Services at 1-844-325-6251, Monday–Friday, 8 a.m.–5 p.m.