Provider manuals and guides

Highmark Blue Cross Blue Shield (Highmark BCBS) is committed to supporting you in providing quality care and services to the members in our network. Here you will find information for assessing coverage options, guidelines for clinical utilization management (UM), practice policies and support for delivering benefits to our members.

Provider Manual

The Highmark BCBS Provider Manual provides key administrative information, including the quality improvement program, the UM program, quality standards for participation, claims appeals, and reimbursement and administration policies.

Medical Policies and Clinical UM Guidelines

Medical policy addresses the medical necessity of new services or procedures and new applications of existing services or procedures. Clinical UM Guidelines focus on detailed selection criteria, goal length of stay, and location for generally accepted technologies or services.

Documents

Provider tools and resources

Interested in becoming a provider in the Highmark BCBS network?

We look forward to working with you to provide quality service for our members.