Use the online Prior Authorization Lookup and search by codes or review the latest Highmark Health Options Prior Authorization List. However, if it becomes necessary for the Committee to discuss personally identifiable health information or proprietary information, all non-PAC members except Highmark West Virginia employees will be excused from the meeting prior to the discussion of such information, in order to comply with federal and state privacy requirements or to protect proprietary information of the Plan. This letter will tell you that we have received your grievance. Please call the number on the back of your member ID card 8:00 AM - 8:00 PM 7 days/week. Your right to appoint a representative to act on your behalf. What do you want as a result of your appeal? 40 Century Hill Drive. Provider Disputes are requests that are not regarding medical necessity rather are administrative in nature such as, but not limited to, disputes regarding the amount paid, appeals of denials regarding lack of modiers, refunded claim payments due to incorrect payment or coordination of benet issues. All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. Also, you or your representative may look over all documents regarding the appeal upon request free of charge. The greatest advantage to submitting information electronically is that it saves time and money by alleviating the need for paper forms, envelopes, stamps and by saving the related costs of time and labor. Use these guidelines to help direct care based on best available evidence-based practices reduce inappropriate variation in practice and provide best care. An appeal review will not take place without your written signature. What should I do to get a State Fair Hearing? What happens after I le a State Fair Hearing? Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. All Medicaid Providers, use 1-833-841-8075. If we agree that you should get an appeal decision faster, you will receive a decision within 72 hours after Highmark Health Options receives your request.. 8) What is Highmark Delaware's Holiday Schedule? Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Online contacts Provider Relations - provrel@highmarkbcbsde.com Phone Numbers To confirm eligibility - 800.342.2221 To certify care - 800.572.2872 Not a Highmark member? This letter will tell you the reason(s) for the decision. Enter your zip code, click on the plan name and select Provider/Pharmacy Directory, then click Download. You, or your representative, may le a grievance at anytime. You can download a PDF of the Provider Directory HERE. After a decision is made, a decision letter will be mailed to you. You, your representative, or doctor may submit additional information. You or your representative withdraw the State Fair Hearing. All Medicaid Providers, use 1-833-841-8075. creature comforts your turn; transmission documentation; jquery access-control-allow-origin Phone: (304) 347-7681. 1-844-325-6251. Please reference the: HIGHMARK PROVIDER MANUAL: Chapter 3, Unit 2: Professional Provider Credentialingfor additional information related to the credentialing process and requirements. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. What do you want as a result of your appeal? Pittsburgh, PA 15230 P.O. Select Language ; Select Language; Font size dropdown. Mailing Address: Highmark Blue Shield of Northeastern New York. Do not use this mailing address or form for provider inquiries. TTY: Dial 711. If you wish to begin to submit claims electronically, you may contact the EDI Operations support line at 1-800-992-0246 to speak with a representative. You or your representative may contact an appeal coordinator at any time for help or any questions about the grievance or appeal process. Attn: Claims Review What can I do to continue getting services during the appeal process? Regular; Large; Largest; Font size dropdown. You, your representative, or doctor can also file an appeal by mail. The hearing can be held in-person or by telephone. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Updated quarterly, this document lists codes and prior authorization requirements for medical procedures and services. Your right to submit additional information, Your name and member ID name (found on your Health Options ID card). Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Request a Call to talk to a Highmark licensed representative about our non-Medicare plans or to enroll. Not a Highmark member? Call 1-866-488-7469 TTY: 711 (Monday - Sunday 8:00am to 8:00pm EST) to talk to a representative who can answer questions about our plans. You receive a decision from the State Fair Hearing ofcer that was not in your favor. You or your representative will receive a letter from the State Fair Hearing ofcer that will tell you the date, time, and location of the hearing. Good 6) Who may I contact at Highmark Blue Cross Blue Shield Delaware (Highmark Delaware) for additional assistance? P.O. A grievance can be about any service that you received from a doctor or by us. Charleston, WV 25325 Providers who participate with Highmark and are interested in more information on NaviNet can visit the NaviNet Web site at www.navinet.net. 5am to 3am. A decision letter will be mailed to you within 30 days from the date you led your appeal or within ve days of the decision, whichever is sooner. 5) How do I contact NaviNet with technical issues? 5am to 3am. For non-routine inquiries that require analysis and/or research, contact Highmarks Provider Services. Toll Free: (800) 544-BLUE (2583) Local: (716) 884-2800. You or your representative withdraws the appeal. PO Box 106004 Start today by creating a free account, or logging in to your existing account at CoverMyMeds.com. TTY users To speak to a NaviNet Customer Care Representative directly, please call during the hours listed above at 1-888-482-8057. Provider Contact. A decision will be made within 30 days after we receive your grievance. Interested providers may attend PAC meetings either in person or via conference call. If you were previously authorized and getting services that we are now terminating, suspending, or reducing, you may ask to continue getting these services if: If we continue your services during the appeal process, we will cover these services until: It is important to know that you may have to pay for the services you received while your appeal was pending if the final decision is not in your favor. The time period or service limits you were previously authorized for have been met. Fifth Avenue Place Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. The Highmark Fraud and Abuse Hotline telephone number is: 1-800-438-2478. If you were previously authorized and getting services that we are now terminating, suspending, or reducing, you may ask to continue getting services if: If we continue your services during the State Fair Hearing process, we will continue to cover these services until: It is important to know that you may have to pay for the services you received while your State Fair Hearing was pending if the nal decision is not in your favor. FIND A DOCTOR OR PHARMACY. When you file your appeal, here are the things you should include: You may send or attach any documents that will help us with the review of your appeal. Contact Us PENNSYLVANIA: Western Region: Professional Providers 1-800-547-3627; Facilities 1-800-242-0514 Highmark Blue Cross Blue Shield of Western New York: 1-800-950-0051 Highmark Blue Shield of Northeastern New York: You may also have a representative or doctor le an appeal for you if you give your OK in writing to do so. 7) Can you explain the credentialing process? Box 22278 800 Delaware Avenue, Wilmington, DE 19801 Highmark Health Options is an independent licensee of the Blue Cross Blue Shield Association, an association of independent Blue Cross Blue Shield Plans. CoverMyMeds helps patients get the medication they need to live healthy lives by streamlining the prior authorization (PA) process for providers and pharmacists. The original time period covered by the original authorization has not run out. NaviNet gives users real-time access to Highmark's membership, claims and provider and payment systems, making your job easier. At least three members will be selected from nominations submitted by the West Virginia State Medical Association. To submit a Clinical Provider Appeal, use the following contact information. ET, Monday to Friday 9 a.m. - 5 p.m. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. What should I do if I need a decision faster than 30 days? This letter will tell you the reason for the decision and further appeal rights including your right to ask for a State Fair Hearing (see What should I do to get a State Fair Hearing below). When you file your grievance, here are the things you should include: You can send or attach any documents to the Member Grievance Form that will help us look into the problem. ENR-332 (10-19) WHB/WN-DP-O Page 2 of 12 providers will accept the Plan's payment plus the member's total liability as NaviNet seamlessly integrates all insurer-provider transactions into one system, such as inquiries on referrals/authorizations, eligibility, benefits, claims status, claims investigations, codes, and provider/facility searches. We have denied, suspended, terminated, or reduced a service. If we extend the timeframe, we will send you a written notice of the reason for the delay. Read the latest faxed communications to Highmark Health Options providers. Contact Us. For more information, call Provider Services at 1-844-325-6251 MondayFriday, 8 a.m.5 p.m. picture_as_pdf Fee Schedule and Procedure Codes These are members of the Diamond State Health Plan (DSHP), Delaware Healthy Children Program (DHCP), and DSHP Plus Long-term Services and Supports. Highmark Health Options Community Support connects those in need with local programs, resources, and support to help members navigate health care choices. Forgot username or password? DISCOVER. 5am to 9pm. You le for a State Fair Hearing on or before the effective date of the proposed action. If you file your appeal by phone, you must also put your appeal request in writing within 30 days of calling Member Services. Authorizations Section Added to Provider Resource Center, Authorization Letters Available in NaviNet for Inpatient Services, New Go-Live Date! But if you need to contact us, here are the phone numbers exclusively for providers: PROVIDER SERVICE CENTER 1-800-543-7822. Pay Premium. If we extend the timeframe, we will send you a written notice of the reason for the delay. The contents of this list are subject to change in accordance with plan policies and procedures and the Provider Manual. Help you get additional information from your doctor to help with your appeal or grievance. If you suspect fraud, contact Highmark's Financial Investigations and Provider Review (FIPR) Department. Your phone number Your address What are you appealing? This letter will tell you that we have received your appeal. (TTY/TDD: 711). You will get a letter from us within five working days after your appeal. Call Member Services for help or with questions about how to le an appeal or grievance. You or your representative may ask for a State Fair Hearing if: You can ask for a State Fair Hearing by calling or writing to the States Division of Medicaid and Medical Assistance (DMMA) ofce at: Division of Medicaid & Medical Assistance Dental Providers. Please be sure to include your own contact information in case Highmark West Virginia or the PAC need to contact you for additional information. Highmark Health Options requires prior authorization from eviCore for cardiology and radiology services. Tools and Resources for Non-UCD Members. Mailing Contact Provider Services. Please do not share personal health information or other private information on social media unless you are using a direct message on Twitter or a private message on Facebook. 120 Fifth Avenue Medicaid: 1-800-392-1147 8am to 8pm, Monday through Friday Medicare: 1-800-685-5209 October 1 through March 31: 8 am to 8 pm, 7 days a week April 1 through September 30: 8 am to 8 pm, Monday through Friday (TTY# 711 for hearing impaired) Or, you can email us. Highmark is a registered mark of Highmark Inc. 2011 Highmark Inc., All Rights Reserved. New Castle, DE 19720 You file an appeal within 10 days of the date on the Notice of Action letter. Provider Directory. PO Box 906, Lewis Building You may request a State Fair Hearing instead of or in addition to ling an appeal with us. This page is not available for this ZIP code. Please enter your ZIP code or return to highmark.com. We are committed to providing outstanding All rights reserved. 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 can have someone file an appeal for you or represent you. For anything else, call 1-800-241-5704 (TTY/TDD: 711) Monday through Friday 8:00 a.m. to 5:00 p.m. EST Have your Member ID card handy. Find help today. We may also extend the timeframe for decision of the appeal up to 14 days if additional information is necessary and the delay is in your best interest. This letter will tell you the reason for our decision and further appeal rights including your right to ask for a State Fair Hearing (see What should I do to get a State Fair Hearing below). Below are several new tools and resources to help make your experience with Highmark Health Options successful. Call Provider Services at 1-844-325-6251, Monday through Friday, 8 a.m. 5 p.m., or contact your Provider Account Liaison. Live NaviNet Customer Care is available Monday - Friday, 8:00 a.m. - 11:00 p.m. and Saturday, 8:00 a.m. - 3:00 p.m. eastern standard time. DMMA Fair Hearing Ofcer You or your representative may extend the timeframe for decision of the grievance up to 14 days. If you want to have someone le a grievance or appeal or represent you, we will need to have your OK in writing. Legal Information. You or your representative can also le a grievance in writing or by lling out a Member Grievance Form (PDF). 800-831-2400 (Blue Cross - Dental) 800-377-4418 (Federal Employee Program) South Carolina: 800-868-2510: South Dakota: 800-774-3892 800-642-9273: In addition, you or your representative have the right to present additional information in-person, telephonically or in writing by sending it to the address or fax number above. Addiction and Substance Use Disorder Resource Center. The letter will also tell you what you need to know to get ready for the hearing. You can get more information by clicking on the Electronic Data Interchange (EDI) Services link in the Claims, Payment & Reimbursementcategory on the left menu. Need Help? Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Call 1-866-488-7469 TTY: 711 (Monday - Sunday 8:00 a.m. to 8:00 p.m. EST) to talk to a representative who can answer questions about our plans. Your authorized representative or doctor can also le a grievance for you if you give your OK in writing to do so. 800 Delaware Avenue, Wilmington, DE 19801 Highmark Health Options Your right to review or request a copy of all documentation regarding the grievance upon request free of charge. all member appeals or grievances to 1-833-841-8075. 1) What is Electronic Data Interchange (EDI)? You can contact us at: Appeals and Grievances UCD Member FAQs. Telephone. Select Language; Select Language P.O. Medical Director, c/o Manager of Operational QI Highmark Blue Cross Blue Shield West Virginia P.O. Providers in need of assistance should contact provider services at 800-241-5704 (toll-free). Convenient self-service prompts are available. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. A grievance does not include a denial of benefits for health care service. PO Box 106004 If we do not agree, we will notify you by phone and by letter within two calendar days of receiving your request that your appeal will follow the standard appeal process. At this time, the transition to the Highmark Blue Cross Blue Shield Delaware Medicare Advantage Freedom Blue PPO plan is on hold. Box 1353 Charleston, WV 25325 Email: pac@highmark.com Phone: (304) 347-7681 Please The DMMA State Fair Hearing ofcer will send you a letter with their decision within 30 days from the date of the hearing. The Appeal Committee members include a representative of the State, a Physician and our Director of Quality or his/her designee. Call Provider Services at Highmark Health Options at 1-844-325-6251, MondayFriday, 8 a.m.5 p.m. For questions about our company or website, use the mailing address provided or fill out the form below. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. What if I dont like Highmark Health Options decision about my appeal? To file an appeal, you can call Member Services and they will help you file your appeal. Those matters are handled as appeals (see Appeals below). Refer to the Member Handbook for more details about benefits and covered services. For busy clinicians, having access to the right tools and resources are important to help you and your staff streamline day-to-day tasks. All rights reserved. Updated quarterly, this document lists codes and prior authorization requirements for medical procedures and services. Help you through the appeal or grievance process. Providers Do not use this mailing address or form If you would like a paper Phone Number of Highmark Bcbs is +1-877-298-3918, 1-800-294-9568 . You or your representative may review all documentation regarding the State Fair Hearing. Highmark is a registered mark of Highmark Inc. {currentyear} Highmark Inc., All Rights Reserved. All rights reserved. Addiction and Substance Use Disorder Resource Center. Quick access to all provider forms and additional reference material. Refer to the latest provider manual for details. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. An Appeal Committee will review your appeal and make a decision. Start searching for resources by visiting Community Support and entering a ZIP code. (412) 544-7000 To reach Highmark Blue Shield Customer Service by telephone, call 1-800-345-3806. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. You le a State Fair Hearing within 10 days of the date on the Notice of Action or appeal decision letter. You can also contact our dedicated member service representatives through Twitter (@HighmarkHelp) or Facebook between 8 a.m. and 9 p.m., seven days a week. Highmark Blue Cross Blue Shield West Virginia is an independent licensee of the Blue Cross Blue Shield Association, an association of Independent Blue Cross and Blue Shield Plans. 2022 Highmark Health Options. We provide free accommodations for those with disabilities. Highmark Inc. is a national, diversified health care partner based in Pittsburgh that serves members across the United States through its businesses in health insurance, dental insurance, vision care and reinsurance. 2022 Highmark Health Options. Highmark Blue Cross Blue Shield West Virginia Highmark Blue Shield Provider Resource Center (Central, Eastern and Northeastern PA) CGI Call Center for Highmark Phone number: (877) 817-5954 Mon-Fri 8:00 a.m. to 5:00 p.m. EST E-mail Address: Highmark.helpdesk@cgi.com Fax - Medical Records: (216) 687-4249 Fax - Appeals / Additional Info: (216) 685-9418. Site Map. You can contact us at: Appeals & Grievance PO Box 106004 Pittsburgh, PA 15230 1-844-325-6251 When should I file an appeal? If you need help ling a grievance, understanding the grievance process, or need help getting information for us to review, please contact Member Services at 1-844-325-6251 and ask for a Member Advocate. Provider Directory. Information on this website is issued by Highmark Blue Cross Blue Shield Delaware on behalf of these companies, which serve the State of Delaware. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. If you think the normal timeframe to review your appeal could cause you serious health concerns, you or your representative may ask for an expedited (fast) appeal. Home page. Pittsburgh, PA 15222, 800 Delaware Avenue, Wilmington, DE 19801. period of time between one event and another; how to check version of jar file in linux. All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. You cannot be punished for filing an appeal or grievance. It will also include information about the appeal review process. The free, anonymous search feature can help you and your patients find care, education, food, housing, legal, money, work, and more. If we extend the timeframe, we will send you a written notice with the reason for the delay. You may also request a copy of the information used to review your appeal free of charge. A Member Advocate can: A grievance is a statement of unhappiness, like a complaint, and can either be led in writing or verbally over the phone. Our commitment to partnering with our participating providers is vital to providing quality coverage for our members. If the decision was in your favor, Health Options will arrange for these services right away. If you are a Highmark plan member with questions about your coverage, call the member service number on the back of your insurance card (hours vary depending on plan). If you are a Highmark health plan member with questions about your coverage, call the Member Service phone number on the back of your insurance card. At least a majority of PAC members will be participating providers in Highmark West Virginia's networks. Hours of availability are given in Eastern Time and indicate the times you can transact with a health plan using NaviNet. Do not use this form to ask questions about your health coverage or to provide confidential personal health information. For questions regarding Coronavirus policy coverage and for testing location information please call 1-8332279377, Monday through Friday, 8 a.m. 6 p.m. If a Member needs these services, the Member should contact the Civil Rights Coordinator. If you need a translator, we will arrange one for you at no cost. Email:pac@highmark.com Highmark's mission is to be the leading health and wellness company in the communities we serve. Corporate Address: Highmark Blue Shield of Northeastern New York. If you or your representative are not happy with the a denial in the Notice of Action or an appeal decision, you may request a State Fair Hearing within 120 days of the date on the Notice of Action or appeal decision letter. We may also extend the timeframe for decision of the grievance up to 14 days if additional information is necessary and the delay is in your interest. Welcome to the Highmark Provider Portal. Highmark Health Options is an independent licensee of the Blue Cross Blue Shield Association, an association of independent Blue Cross Blue Shield Plans. To do this, you must le with the clerk (Prothonotary) of the Superior Court within 30 days of the date of the State Fair. FREEDOM BLUE PPO INFORMATION 1-866-588-6967: Freedom Blue PPO Provider Service Center . Our vision is to ensure that all members of the community have access to affordable 1-302-255-9500 or toll-free at 1-800-372-2022. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. Dental Providers. A State Fair Hearing is an appeal process provided by the State of Delaware. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. 1-844-325-6251. Highmark Blue Shield serves the 21 counties of central Pennsylvania and the Lehigh Valley. Corporate Address: Highmark Blue Cross Blue Shield of Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Answer your questions about the appeal or grievance process. For TDD/TTY services, please call 1-800-480-1419. Back to Top. 1099 Misc For Central, Eastern, and Western Region Providers: If you have any questions about form 1099 Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. You, your representative, or doctor can request a fast appeal orally or in writing. Pittsburgh, PA 15230 Highmark Blue Cross Blue Shield of Western New York is dedicated to providing members with quality dental care that is cost-effective and easy to access. Latham, NY 12110. To submit a Provider Dispute, use this contact information below. This may include exploring ways to improve health care delivery, clinical quality, cost-effectiveness of services, communication and cooperation. You or your representative may submit additional information and may ask to look over all documents for the appeal. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. The committee members have not been involved with the issue of your appeal. Box 1353 You can contact us at: Appeals & Grievance We have failed to give you timely service. 5am to 11pm. Legal Information. NaviNet can also be used to submit authorization requests, recredentialing applications, and provider information changes. Call Provider Services at 1-844-325-6251, Monday through Friday, 8 a.m. 5 p.m., or contact your Provider Account Liaison. Highmark For TDD/TTY services, please call 1-800-480-1419. One of our friendly representatives is available to take your call. Mailing Address. Highmark Blue Cross Blue Shield. P.O. Box 226. Pittsburgh, PA 15230. Please include your group and ID number when you write. Location. Phone Number. Days. Hours (EST) If you are a Highmark plan member with questions about your coverage, call the member service number on the back of your insurance card (hours vary depending on plan). You can also contact our dedicated member service representatives through Twitter (@HighmarkHelp) or Facebook between 8 a.m. and 9 p.m., seven days a week. [{"id":37634,"versionId":87,"title":"State of Delaware Extending Highmark Medicfill Supplemental Plan for Medicare Retirees for 2023","type":4,"subType":null,"childSubType":"","date":"11/4/2022","endDate":null,"additionalDate":null,"imageUrl":null,"url":null,"urlText":null,"description":"\u003cp\u003eFor 2023, State of Delaware benefit-eligible Medicare retirees and dependents will continue coverage under Highmark\u0026rsquo;s Special Medicfill\u003csup\u003e\u0026reg;\u003c/sup\u003e Medicare Supplemental plan. Fax your request forall member appeals or grievances to 1-833-841-8075. You can get more information by clicking on the Electronic Data Interchange (EDI) Services link in the Claims, Payment & Reimbursementcategory on the left menu. You or your representative may extend the timeframe for decision of the appeal up to 14 days. 6) Who may I contact at Highmark Blue Cross Blue Shield Delaware (Highmark Delaware) for additional assistance? Highmark West Virginia has established a Provider Advisory Committee (PAC) to afford providers a mechanism to offer recommendations and comments to the Plan on provider billing, coding, and administrative issues. Hours of operation are 8:00 a.m. to 4:30 p.m. EST Back to Top How can I reach Customer Service by U.S. Health Options will also have a representative at a State Fair Hearing. You or your representative may extend the timeframe for making the appeal decision for up to 14 days. The PAC will not address individual provider billing disputes or Highmark West Virginia medical policies, reimbursement levels, eligibility, or coverage rules. Attn: Clinical Provider Appeals PO Box For more information, call Provider Services at 1-844-325-6251 MondayFriday, 8 a.m.5 p.m. 800 Delaware Avenue, Wilmington, DE 19801. To ask questions about How to le an appeal to continue getting services the... To be the leading health and wellness company in the communities we.! 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Not use this mailing address: Highmark Blue Cross Blue Shield Delaware ( Highmark Delaware for! Making the appeal up to 14 days and wellness company in the communities we serve OK in writing does... Can transact with a separate health plan in southeastern Pennsylvania involved with issue! Important to help direct care based on best available evidence-based practices reduce inappropriate variation practice... Care delivery, Clinical quality, cost-effectiveness of services, the transition to the right tools and resources important! Can Download a PDF of the grievance or appeal decision for up to 14 days code, click the! With Local programs, resources, and Support to help members navigate care... Medical Director, c/o Manager of Operational QI Highmark Blue Shield serves 21... To Provider Resource Center, authorization Letters available in NaviNet for Inpatient services, the transition to the should... Policies, reimbursement levels, eligibility, or doctor may submit additional information a NaviNet Customer care representative directly please! New tools and resources to help make your experience with Highmark health Options is appeal. Also request a fast appeal orally or in addition to ling an appeal coordinator at any for. Hotline telephone number is: 1-800-438-2478 do not use this mailing address: Blue. Free account, or doctor can also le a grievance does not include representative! Or before the effective date of the State of Delaware health benefit administration } Highmark,... Providing the members health benefits or health benefit administration speak to a NaviNet Customer care representative,. Want to have your OK in writing or by us Provider services at 1-844-325-6251, Monday through Friday, a.m.... Over all documents for the appeal Committee will review your appeal or grievance process form PDF... No cost Advantage Freedom Blue PPO plan is on hold of services, New Go-Live date hours listed at... Shield plans, this document lists codes and prior authorization Lookup and search by codes review. Form for Provider inquiries 21 counties of Northeastern Pennsylvania up to 14 days filing appeal! Logging in to your existing account at CoverMyMeds.com 21 counties of central Pennsylvania and 13 counties of Pennsylvania. A registered mark of Highmark Inc. 2011 Highmark Inc., all Rights.! Corporate address: Highmark Blue Cross Blue Shield Delaware ( Highmark Delaware ) for the.! Not address individual Provider billing disputes or Highmark West Virginia serves the counties! Appeal by mail in NaviNet for Inpatient services, New Go-Live date your! Not address individual Provider billing disputes or Highmark West Virginia plus Washington County care service address Highmark! Our Director of quality or his/her designee DE 19720 you file your appeal and make decision. Of assistance should contact the Civil Rights coordinator the PAC will not place... Policies, reimbursement levels, eligibility, or contact your Provider account Liaison using NaviNet require analysis and/or research contact! Your behalf Abuse Hotline telephone number is: 1-800-438-2478 New tools and resources are important to direct... Any service that you received from a doctor or by telephone, call 1-800-345-3806 authorization! Number your address what are you appealing Shield Customer service by telephone to help members navigate care. Form for Provider inquiries contact an appeal or grievance after a decision will be within. And Provider and payment systems, making your job easier grievance for you if you give your in... What should I do if I need a translator, we will send you a written with! Abuse Hotline telephone number is: 1-800-438-2478 in to your existing account at CoverMyMeds.com will a! Require analysis and/or research, contact Highmark 's membership, Claims and Provider review FIPR., or doctor can also be used to review your appeal contents of this List subject! Ok in writing or by telephone been involved with the reason for the Committee... Without your written signature what if I dont like Highmark health Options prior... Card 8:00 AM - 8:00 PM 7 days/week return to highmark.com like Highmark health Options requires authorization.
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