Provider resources overview
We are committed to supporting you in providing quality care and services to the members in our network. Here, you will find frequently used forms, PDFs, provider manuals and guides, prior authorization information, practice policies, and support for delivering benefits to our members.
Provider forms
Provider forms are located in our online library for easy access.
Training academy
Highmark Blue Cross Blue Shield (Highmark BCBS) offers training and tutorials to support providers in continuing their education. We will add additional training documentation as they become available.
Provider manuals and guides
Highmark BCBS provider manuals and guides provide key administrative information, including the quality improvement program, the utilization management program, quality standards for participation, claims appeals, reimbursement and administration policies.
Learn about Availity
Many of the tools you need — such as eligibility and benefits inquiry, claims submission, claims status inquiry, and authorizations — can now be accessed by logging into your account on the Availity Essentials .
Precertifications
Highmark BCBS makes determinations based on selected inpatient or outpatient medical services including surgeries, major diagnostic procedures and referrals to validate medical necessity.
Additional information
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
Behavioral health
The Highmark BCBS behavioral health provider network includes psychiatrists, psychologists, social workers, psychiatric nurses, and other mental health and employee assistance health care professionals. Our facility network includes hospital inpatient units, residential treatment centers, partial hospitalization programs and intensive outpatient services and programs.
Provider tools and resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Precertification lookup tool
- Precertification requirements
- Claims overview
- Member eligibility & pharmacy overview
- Provider manual and guides
- Referrals
- Forms
- Training Academy
- Pharmacy information
- Electronic Data Interchange (EDI)