Highmark wholecare prior authorization

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This information will be used for purposes of performing services to, or on behalf of, our enterprise customers and prospective customers as part of and in relation to matters regarding our provider, health plan, and subsidiary enterprise care delivery, administration and operations. Your email address and phone number may be used to contact you. All reasonably appropriate measures will be taken to prevent disclosure of your Personal Data beyond the scope provided directly or indirectly herein or as may be reasonably inferred from the content contained in this notice or the website. Your Personal Data will be disclosed to appropriate personnel for purposes of performing services to, or on behalf of, our enterprise customers and prospective customers as part of and in relation to matters regarding our provider, health plan, and subsidiary enterprise care delivery, administration and operations. Notwithstanding the above disclosures, we will disclose the Personal Data we collect from you under the following circumstances:. We use third-party service providers to process Personal Data, including, without limitation, for information storage and other similar purposes.

Highmark wholecare prior authorization

When considering medications from a class included on the Statewide PDL for MA beneficiaries, providers should try to utilize drugs that are designated as preferred. Drugs designated as non-preferred on the Statewide PDL remain available to MA beneficiaries when determined to be medically necessary through the prior authorization process. The Statewide PDL is a list of medications that are grouped into therapeutic classes based on how the drugs work or the disease states they are intended to treat. The committee's recommendations are approved by the secretary of the Department of Human Services DHS prior to implementation. The Statewide PDL is therapeutically based. The committee's recommendations are based on the clinical effectiveness, safety, outcomes, and unique indications of all drugs included in each PDL class. When drugs within a class are clinically equivalent, the committee considers the comparative cost-effectiveness of the drugs in the class. Back to Table of Contents. All non-preferred drugs on the Statewide PDL remain available to MA beneficiaries when found to be medically necessary. All drugs designated as non-preferred on the Statewide PDL require prior authorization through the beneficiary's pharmacy benefits provider. Some preferred drugs on the Statewide PDL require a clinical prior authorization. All preferred drugs that require clinical prior authorization remain available to MA beneficiaries when found to be medically necessary. All drugs designated as preferred with clinical prior authorization on the Statewide PDL require prior authorization through the beneficiary's pharmacy benefits provider. Prior authorization requests for beneficiaries who receive their pharmacy benefits through the Fee-for-Service delivery system should be directed to the DHS Pharmacy Services division.

Message Center. We have a number of step-by-step reference guides available to assist providers in the authorization process:. You also explicitly consent to the automated decision making by us, which highmark wholecare prior authorization include the processing of your health data, to the extent that it is necessary to process your health claim swiftly and efficiently.

October 1 — March 31, 8 a. Please note that a representative may contact you to confirm receipt of information. By providing your email you will receive confirmation of your request as well as other helpful information from Highmark Wholecare. Enrollment in these plans depends on contract renewal. Highmark Wholecare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Highmark Wholecare does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Starting January 1, , Highmark Wholecare will no longer require prior authorization for over services. A listing of the affected Medicare and Medicaid services can be found on our website here. We value your continued partnership and hope this update will help add administrative efficiencies. If you have any questions, please reach out to your Provider Account Liaison. 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. You're being redirected to the CMS search site. Quick Links: Manuals. Medicare Provider Manual. Medicaid Provider Manual.

Highmark wholecare prior authorization

As a provider, you have access to a wide variety of tools and resources designed to help you deliver better service. If you haven't already done so, follow these simple steps to get the most out of your Highmark Wholecare partnership. Join our network by completing this form. Login to the provider portal. Review and download Medicare Assured and Medicaid Policies.

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At MedExpress, we understand that accidents and illness can happen anytime. Llame al TTY All Medicaid covered drugs are available to beneficiaries when medically necessary regardless of the drugs' inclusion on the Statewide PDL. Please bring with you: all items on "for patient" list completed Employer Authorization Form for a general visit or a completed Workers' Compensation Initial Visit Form for a workers' compensation visit any documents needed for a DOT physical For a DOT physical, please call to ensure a DOT-certified provider will be available. This information will be used for purposes of performing services to, or on behalf of, our enterprise customers and prospective customers as part of and in relation to matters regarding our provider, health plan, and subsidiary enterprise care delivery, administration and operations. Your email address and phone number may be used to contact you. This is not a valid zip code Required. Get your free kit! Search the Site: Submit Search. Your Personal Data will remain on file for: any period required by applicable law; and, to the extent necessary for any purpose s provided directly or indirectly herein or as may be reasonably inferred from the content contained in this notice or the website, but no longer than permitted by applicable law.

Introducing a new provider resource experience that simplifies getting you the information you need, when you need it. Your feedback is appreciated as we work to complete the experience. The authorization is typically obtained by the ordering provider.

MedExpress Insurance Section. Questions about authorization workflows. If you have questions regarding how we process your Personal Data and what we store about you, please contact PrivacyInternational HighmarkHealth. Please note that a representative may contact you to confirm receipt of information. Services centered around you. All Medicaid covered drugs are available to beneficiaries when medically necessary regardless of the drugs' inclusion on the Statewide PDL. The committee's recommendations are based on the clinical effectiveness, safety, outcomes, and unique indications of all drugs included in each PDL class. Better Health Workplace Wellness. Please enable scripts and reload this page. Additional information regarding quantity limits for beneficiaries who receive their pharmacy benefits from one of the HealthChoices or Community HealthChoices MCOs is available directly from each MCO. Message Center. Some authorization requirements vary by member contract. Please view your local center page to view accepted insurance plans for your specific location. Highmark Wholecare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. All reasonably appropriate measures will be taken to prevent disclosure of your Personal Data beyond the scope provided directly or indirectly herein or as may be reasonably inferred from the content contained in this notice or the website.