The Highmark Provider Resource Center offers healthcare professionals a comprehensive online platform designed to streamline administrative processes, access critical information, and manage patient care efficiently. This digital portal serves as a centralized hub for providers participating in Highmark networks across multiple regions.
Official Links
- Provider Portal: https://providers.highmark.com/
- Member Guide: https://www.highmark.com/member/member-guide
What Providers Can Do
Healthcare professionals using the Highmark Provider Portal can:
- Submit authorization requests
- Check claim statuses
- Access medical policies
- Validate patient eligibility and benefits
- Review reimbursement programs
- Access provider training resources
Access and Authentication
Login Requirements
- Providers must authenticate through Availity
- Secure login ensures protected access to sensitive healthcare information
- Multiple regional networks supported (DE, WPA/NEPA, WNY, WV, NENY)
Key Portal Features
Claims and Authorization
- Authorization guidance
- MCG Clinical Criteria access
- Gold Carding Program information
- Fee schedule details
Medical Policies
- Comprehensive medical policy search
- Frequently asked questions
- Clinical criteria resources
- Care management programs
Pharmacy Resources
- Pharmacy policy search
- Formulary information
- Pharmaceutical management programs
Network Management
- Credentialing processes
- Provider directory
- High-performance network details
Privacy and Security
The portal emphasizes:
- Strict authentication protocols
- HIPAA compliance
- Secure information transmission
- Protected access to sensitive healthcare data
Support and Resources
Provider Support
- Provider Service Center
- Operating hours: 8 a.m. to 5 p.m. EST, Monday through Friday
- Direct contact options for unresolved queries
Technical Support
Availity Platform
- Comprehensive training resources
- Transaction support
- Reporting capabilities
- Enhancement tracking
Unprovided Information
Some specific details were not explicitly available in the source documents, including:
- Exact step-by-step login process
- Comprehensive list of all portal features
- Detailed authentication workflow
The Highmark Provider Portal represents a robust, secure digital platform enabling healthcare professionals to efficiently manage patient care, administrative tasks, and network interactions with streamlined, comprehensive tools.
Contact Information
- Provider Service Center: Available during business hours
- Recommended first step: Login via Availity platform
Note: Always refer to the most current information directly from Highmark’s official resources.
FAQ
Are Blue Cross Blue Shield, and Highmark the same?Highmark Inc. is an independent licensee of the Blue Cross Blue Shield Association.
How do I contact BCBS Highmark?Members can get assistance with their renewal via our retention call center at 844-885-1004 (TTY 711), through the NY State of Health website or calling 855-355-5777. If you have questions about eligibility, benefits, authorizations, claims status, and more, log in to Availity Essentials* and select Chat with Payer.
Does Highmark BCBS cover Ozempic?
Where do I send my claims to Highmark Blue Cross Blue Shield of Pennsylvania?
| If type of claim is… | Mail to… |
|---|---|
| Highmark Blue Shield Medical – Surgical Claims | Claims Processing P.O. Box 890062 Camp Hill, PA 17089-0062 |
| Highmark Blue Shield Indemnity – Major Medical | Highmark Major Medical P.O. Box 890393 Camp Hill, PA 17089-0393 |
https://providers.highmark.com/
Provider News, Medical Policy Update, Portal Message Library & Special Bulletins d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company
https://www.highmark.com/member/member-guide
My Highmark is the one-stop app for all of your plan benefits. Simply use your same login from the member website to easily manage your health care.