Highmark’s medical policy guidelines address both clinical and claim payment reimbursement issues. These guidelines address hundreds of medical issues, including diagnostic and therapeutic procedures, injectable drugs, and durable medical equipment. Some policies address procedures and services that are considered to be part of another procedure or service and, as such, are not separately payable. Many of these clinical and reimbursement guidelines are automated in our claims processing system.
You may search for topics by Keyword, Procedure Code or Policy Bulletin Number.
Medical policy guidelines for all of Highmark's medical-surgical products, including managed care.
Medical policy information that is appropriate for Medicare Advantage products.
Highmark does business in Western, Northeastern and North Central Pennsylvania as Highmark Blue Cross Blue Shield. In the remainder of Pennsylvania, we do business as Highmark Blue Shield. References to Highmark represent both Highmark Blue Cross Blue Shield and Highmark Blue Shield.