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 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.
Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. 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. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. 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. All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration.
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