Quick Links:
Manuals
Highmark Provider Manual
WVFH Provider Manual
Medical Policy
Medical Policy
Medical Policies
Medicare Advantage Medical Policies
eSubscribe
Requiring Authorization
Pharmacy Policy Search
Message Center
Manuals
Highmark Provider Manual
WVFH Provider Manual
Medical Policy Search
Medical Policy Search
Medical Policies
Medicare Advantage Medical Policies
Pharmacy Policy Search
Requiring Authorization
eSUBSCRIBE
Site Map
COVID-19
COVID-19 (Coronavirus) Information
Telemedicine Webinar
Telemedicine and Virtual Visits
No Surprises Act
No Surprises Act
Authorizations
Authorization Forms
Procedures/Service Requiring Prior Authorization
Care Management Programs
Advanced Imaging and Cardiology Services Program
Behavioral Health Resources
Behavioral Health Telemedicine and Virtual Visits
DIP Levels
Laboratory Management Program
Musculoskeletal Surgery and Interventional Pain Management Services Prior Auth Program
Oncology Management Pathways Program
Physical Medicine Management Program
Post-Acute Care Management for Medicare Advantage Members
Prior Authorization/Notification Information - Radiology Management Program
Privileging Application and Requirements - Radiology Management - WV
Radiation Therapy Authorization Program
Radiology Management Program Info
Radiology Management Program WV Clinical Guidelines
Right Care Program
Claims, Payment & Reimbursement
APC Pricing Component Update Calendar
Auditor’s Scoring Worksheets for All E/M Services Prior to 2021
Auditor’s Scoring Worksheets Using 95/97 Guidelines for E/M Services Other Than Outpatient/Office E/M Services 2021
Documentation Guidelines for Evaluation and Management Services
Electronic Data Interchange (EDI) Services
Facility Reimbursement Manual
Fee Schedule Information
Guidelines for HUD/HUE
Highmark Coding Tips
Hospital Outpatient Prospective Payment System (OPPS) Based Payment Method
List of Procedure Codes Requiring NDC Information
MCG Clinical Criteria
Medical Policy
Medical Policy Frequently Asked Questions (FAQs)
Medical Policy Update Newsletter
Medically Unlikely Edit Update Schedule
Oncology Management Pathways Program Fee Schedule
Procedure Terminology-Based Combinations
Procedures/Service Requiring Prior Authorization
Reimbursement Policy
Reimbursement Policy Archive
Credentialing
Organizational Behavioral Health Initial Credentialing Set Up
Organizational Initial Credentialing Set Up
Organizational Credentialing Forms
Professional Initial Credentialing Set Up
Initial Credentialing Request Form
Education/Manuals
axialHealthcare Substance Use Risk and Recovery Programs
Behavioral Health ACM Authorization Submission Manual
Behavioral Health Practice Resources
Behavioral Health Toolkit - Antipsychotic Medication Indications
Behavioral Health Toolkit - Anxiety Disorders
Behavioral Health Toolkit - Attention Deficit/Hyperactivity Disorder (ADHD)
Behavioral Health Toolkit - Autism
Behavioral Health Toolkit - Bipolar Disorder
Behavioral Health Toolkit - Crisis Resources
Behavioral Health Toolkit - Depression
Behavioral Health Toolkit - Eating Disorders
Behavioral Health Toolkit - Insomnia and Sleep
Behavioral Health Toolkit - Post-Traumatic Stress Disorder (PTSD)
Behavioral Health Toolkit - Psychotherapy
Behavioral Health Toolkit - Self-Care For Providers
Behavioral Health Toolkit - Substance Use Disorder and Opioid Use
Behavioral Health Toolkit - Suicide Prevention Resources
Behavioral Health Toolkit for Primary Care Physicians
CAHPS®/QHP EES Survey Results
Coding Education/HCC University
Educational Resources - Member and Provider
Emergency Department Utilization
Facility Reimbursement Manual
HEDIS®
Helion Provider Portal Onboarding Guide
Highmark Provider Manual
Highmark Provider Manual Appendix - WV
Highmark Provider Manual Archive
Highmark Provider Manual Tip Sheet Index
Improving Blood Pressure Control
Inventory Request Form
Inventory Request Form
Medicare Advantage Member Evidence of Coverage Booklets
Medicare Advantage Supplemental Requirements
Office Site and Medical Record Evaluation Forms
Optimizing Treatment In The Patient With Rheumatoid Arthritis
PCP and OBGYN Practice Resources
Population Health University
Population Health University - Additional Resources
Population Health University - All Resources A-Z
Population Health University - Care Management
Population Health University - Clinical Pharmacy Resources
Population Health University - Disease Management
Population Health University - PI Tool
Population Health University - PI Tool Newsletter
Population Health University - VBR Program Resources
Practice Site Resources
Preventive Health Guidelines
Provider Data Accuracy Compliance
Provider File Management: NaviNet Guide
Reference Guide of Highmark Member Programs
Risk Adjustment Programs
SilverSneakers
Transitions of Care
WVFH Medicaid Primary Care Incentive Program
WVFH Provider Manual
Forms
Authorization Forms
Behavioral Health Forms
Certificate of Medical Necessity (CMN) for DME Providers
FEP Medical Health Forms
Medical Injectable Drugs
Miscellaneous Forms
Pharmacy Prior Authorization Forms
Professional Initial Credentialing Set Up
Provider Information Management Forms
Inter-Plan Programs
Blue Distinction Centers For Specialty Care Program
BlueCard Information Center
Electronic Provider Access (EPA) for Pre-Service Review
Medical Policy and Pre-certification Pre-authorization Information for Out-of-Area Members
Medicare Advantage PFFS Search
Newsletters/Notices
COVID-19 (Coronavirus) Information for Providers
e-Subscribe for Publications and Notifications
Facility Bulletins (2014 & older)
Helion Bulletin
Hot Topic Library
Hot Topic Library - 2014
Hot Topic Library - 2015
Hot Topic Library - 2016
Medical Policy Update Newsletter
Plan Central Library
Plan Central Library
Plan Central Library - 2013
Plan Central Library - 2014
Plan Central Library - 2015
Plan Central Library - 2016
Plan Central Library - 2017
Plan Central Library - 2019
Plan Central Library - 2021
Plan Central Library - 2022
Plan Central Library - WV
Provider News
Special Bulletins & Mailings
Pharmacy Program/Formularies
Channel Alignment Program
Diabetes Medications Dosing Guide
Formulary Information
Formulary Updates
Free Market Health
Hemophilia and Bleeding Disorder Drug Program
List of Procedure Codes Requiring NDC Information
Managed Prescription Drug Coverage (MRxC)
Medical Injectable Drug Program - WV
Medicare Formularies
Pharmaceutical Management (Clinical Management Programs) - WV
Pharmacy Benefits Program WV
Pharmacy Information
Pharmacy Policies - SEARCH
Prescription Drug Prior Authorization - WV
Process for Requesting Drug Coverage from a Pharmaceutical Management Program
Program for Self-Administered Injectable or Oral Biotechnology Drugs
Site of Care Drug Management Program
What is the Formulary?
Product Information
Product Information
Provider Training
Provider Orientation
Provider Training
Value-Based Reimbursement Programs
2016 Medicare Advantage Stars Primary Care Incentive Program
2016 Medication Reconciliation Post Discharge-Gap Closure Incentive Program
2018 Medicare Advantage Stars Primary Care Incentive Program
2019 Medicare Advantage Stars Primary Care Incentive Program
2020 Medicare Advantage Stars Primary Care Incentive Program
2021 Medicare Advantage Stars Primary Care Incentive Program
2021 Medicare Advantage Stars Primary Care Incentive Program
Annual Wellness and Initial Preventive Physical Exam Rate
Breast Cancer Screening
Colorectal Cancer Screening
Controlling High Blood Pressure
Eye Exam for Patients with Diabetes
Follow-up After Emergency Department Visit for Patients with Multiple Chronic Conditions
Hemoglobin A1c Control for Patients with Diabetes
Inter-Plan Medicare Advantage Care Management and Provider Engagement Program
Medicare Advantage Member and Provider Programs (WV)
Medicare Advantage Stars
Medicare Advantage Stars About - PA, WV, DE NaviNet
Medication Adherence for Cholesterol (Statins)
Medication Adherence for Diabetes Medication
Medication Adherence for Hypertension (RASA)
Medication Therapy Management
Member Wellness Rewards
Osteoporosis Management in Women Who Had a Fracture
Patient Engagement After Inpatient Discharge
Plan All-Cause Readmissions: Medicare Advantage
Provider Templates for Mailing to Patients
Quality Blue Hospital Program
Screening for Future Fall Risk
Specialist Performance Initiative
Statin Therapy For Patients With Cardiovascular Disease
Statin Use in Persons with Diabetes
TRC (Transitions of Care) Medication Reconciliation Post-Discharge
True Performance Home Health Pay-for-Value Program
True Performance Lite Program
True Performance Program
True Performance Skilled Nursing Facility Pay-For-Value Program
Value-Based Programs
Vendor Partner: AdhereHealth
Vendor Partner: Home Access
Vendor Partner: Matrix
Virtual Health
Virtual Health
Other Resources
Highmark 2018: Important Product News
Highmark West Virginia PRC Home
Legal Information - WV
Message Center - WV
Provider FAQ
Provider Orientation
Report Site Issues
Site Map
To Top