Use the online Prior Authorization Code Lookup for Medicaid or Medicare D-SNP and search by codes. 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.
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.
Get Started with CoverMyMeds
Highmark Health Options and Highmark Health Options Duals requires prior authorization from HealthHelp for the following services:
To help streamline how you manage these requests for your Highmark Health Options Duals (HMO-SNP) and Highmark Health Options* patients, HealthHelp is implementing single sign on (SSO) capability within NaviNet on Jan. 1.
If you are an existing NaviNet user, you will need to:
*SSO for HealthHelp through NaviNet will be available for Highmark Health Options in March 2025. Prior Authorization requests for HHO patients should be sent to HealthHelp via fax at 877-637-6934 or by phone at 877-761-1444.
If you are contracted with both HHO Duals and HHO, you will have access to SSO through NaviNet. Authorization requests for HHO (Medicaid) patients can be put through by selecting Highmark Health Options – Delaware D-SNP.
** Note: If you already have an email on file, you will need to click “link account”.
If you do not already have a NaviNet account for other health plans, you will need to register to access HealthHelp SSO for prior authorization requests.
Get started with NaviNet
Streamline your claim processing with PNC Healthcare's Payer Resource Center. This user guide provides a step-by-step walkthrough of the CPR system, covering login procedures, various search options (including by ECHO Draft Number, Provider ID, and Certificate Number), file management, payment approval history, and detailed report generation. Learn how to access and interpret key documents like EOBs, EODs, EPPs, and 835 files. Additionally, discover how to utilize optional enhanced features such as the Reconciliation Link and the 835 Score Card for enhanced payment tracking and data analysis. This guide empowers you to efficiently manage your claims and optimize your revenue cycle.
Download the User Guide
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 Now
Health professionals, patients, and consumers can voluntarily report adverse events of human medical products. Adverse events may be suspected or observed, and they include problems or use/medication errors. Voluntary reporting helps bring to attention to unknown risks for FDA-approved medical products. Reporting can be done by phone, by fax, through the FDA MedWatch online reporting portal, or by downloading, completing, and submitting the FDA Form 3500 (Voluntary Reporting).
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.
