Precertification requirements

To request or check the status of a prior authorization request or decision for a particular plan member, access our Interactive Care Reviewer (ICR) tool via Availity. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate.

Don’t have an Availity account?

Need help with Availity?

Behavioral health

Fax all requests for services that require precertification to:

Services billed with the following revenue codes always require precertification:

0240–0249 All-inclusive ancillary psychiatric
0901, 0905–0907, 0913, 0917 Behavioral health treatment services
0944–0945 Other therapeutic services
0961 Psychiatric professional fees

Pharmacy

Check our Preferred Drug List

Services billed with the following revenue codes always require precertification:

0632 Pharmacy multiple sources

Nonparticipating providers

All services you render require precertification.

Fax:

1-800-964-3627

Call:

1-866-231-0847

Related information

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.