Prior authorization highmark delaware

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We know the healthcare system can be complex, and it can be made even more daunting when you or a family member are dealing with health issues or an emergency. What you should know: Delaware is changing its Medicare plan for state workers, here's what it means for retirees.

In February, the SEBC approved a plan that was included in the Fiscal Year budget assuring that retirees and their dependents continue to receive premium health care services through a customized Medicare Advantage plan specifically designed by Highmark Blue Cross Blue Shield Delaware.

The coverage for Medicare services and prescription drugs remains the same as the past Medicare Supplement plan. State pensioners and their dependents have the same access to doctors and hospitals who accept Medicare.

Highmark Blue Cross Blue Shield Delaware will continue to administer the State Medicare health plan, just as it has for many years with:. The new plan takes effect on January 1, , with open enrollment Oct. We understand any change can be met with concern. If you are a state pensioner with questions about the plan, please contact Highmark Concierge Service: available 7 days a week from 8 a. And like the health coverage available to State employees and pensioners not yet eligible for Medicare, the Medicare Advantage plan will require prior approval for some non-emergency services.

Say you were sent to a specialist because you had intense back pain and needed an MRI. Benefit plans vary widely and are subject to change based on the contract effective dates.

The provider is responsible for verification of member eligibility and covered benefits. Effective dates are subject to change. Highmark will provide written notice when codes are added to the list; deletions are announced via online publication. Examples of services that may require authorization include the following.

This is not an all-inclusive list. Benefits can vary; always confirm member coverage. The online portal is designed to facilitate the processing of authorization requests in a timely, efficient manner.

If you are a Highmark network provider and have not signed up for NaviNet, learn how to do so here. Highmark recently launched a utilization management tool, Predictal, that allows offices to submit, update, and inquire on medical inpatient authorization requests.

Fax: If you are unable to use NaviNet, you may also fax your authorization requests to one of the following departments. The associated preauthorization forms can be found here. Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number , which can be found here.

Highmark contracts with WholeHealth Networks, Inc. To request an authorization for post-acute care services for Medicare Advantage members, you'll need to complete one of the following forms found here. Additional information about the programs and links to prior authorization codes are available under Care Management Programs in the left website menu.

Authorization number not appearing, unable to locate member, questions about clinical criteria screen. Contact Us. Provider Directory. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Quick Links: Manuals.

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Benefits can vary; always confirm member coverage. The online portal is designed to facilitate the processing of authorization requests in a timely, efficient manner. If you are a Highmark network provider and have not signed up for NaviNet, learn how to do so here.

Highmark recently launched a utilization management tool, Predictal, that allows offices to submit, update, and inquire on medical inpatient authorization requests. Fax: If you are unable to use NaviNet, you may also fax your authorization requests to one of the following departments. The associated preauthorization forms can be found here.

Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number , which can be found here. Highmark contracts with WholeHealth Networks, Inc.

To request an authorization for post-acute care services for Medicare Advantage members, you'll need to complete one of the following forms found here. Additional information about the programs and links to prior authorization codes are available under Care Management Programs in the left website menu. Authorization number not appearing, unable to locate member, questions about clinical criteria screen. Contact Us. Provider Directory. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania.

Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Quick Links: Manuals. Highmark Provider Manual. Health Options Provider Manual. Medical Policy Medical Policy. Medical Policies.

Medicare Advantage Medical Policies. Requiring Authorization. Please review these materials and be prepared to contact NIA before ordering certain diagnostic procedures. You can obtain prior authorizations for non-emergent, high-tech outpatient radiology services through NaviNet, our secure web-based provider portal.

NaviNet is available to request and verify affected services, and check member eligibility, saving you the time and effort of faxing or making a phone call. You'll receive immediate approval, or notification for further review, if it's needed. If your office is not already registered for NaviNet, we encourage you to visit navinet. If necessary, you may able request authorizations by contacting NIA via telephone at the toll-free number listed in the reference guides.

Effective Oct. Back to Radiology Management Home Page. Contact Us. Provider Directory. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Quick Links: Manuals. Highmark Provider Manual.