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Highmark Medical Policy Updates Available Online – December 2022

December 20, 2022

Please note: For dates of service January 1, 2023 and after, you should review Highmark’s medical policies located on the Provider Resource Center (PRC).


We recently reviewed 40 medical protocols.

These policies will be posted online on or before January 1, 2023 and will apply for dates of service prior to January 1.

  • Please refer to the cover letter for brief summaries of new or changed protocols
  • Please note that some of the protocol updates may not pertain to all members
  • If you need help finding specific protocol updates, please contact Provider Service at 1-800-950-0051 or 716-884-3461


Highmark’s monthly Medical Policy Update Newsletter will be available online on or before December 22. These changes may impact your patients who have moved onto Highmark’s system. Policy updates described in the newsletter will be effective March 27, 2023 and can be reviewed by clicking on the link below.

All medical policies for Highmark system patients can be reviewed by clicking on the link below.

Recent Articles

  • Introducing Highmark’s Provider News
    As part of our affiliation with Highmark, we want to create a more seamless and enhanced provider experience. To support this, we will transition our monthly provider communication from “Blue Bulletin” to “Provider News.” Beginning in January, you’ll receive Highmark’s monthly Provider News emails at the end of each month replacing Blue Bulletin. Provider News will deliver local information to help you work with us, including reimbursement, coding, preauthorization, and policy updates. In this article, you can find more information and view the Provider News webpage on the Highmark Provider Resource Center (PRC).
  • Reminder: Highmark Commercial and Medicare Advantage Reimbursement Policies
    As a reminder, on January 1 after all your Highmark Blue Cross Blue Shield of Western New York patients are on Highmark’s systems, we will be following Highmark’s reimbursement policies for commercial and Medicare Advantage lines of business. Here, you can find out how to access Reimbursement Policies on the Highmark Provider Resource Center (PRC).
  • Population Health University - Clinical Pharmacy Resources Available Online
    Before discussing, prescribing, and deprescribing certain medications with your Highmark Blue Cross Blue Shield of Western New York patients, Highmark’s Population Health University offers clinical pharmacy resources to assist you. In this article, you can learn how to access the toolkits that provide useful pharmacy guidance.
  • Provider Tools and Resources Remaining on the Legacy Website
    Our legacy provider website will be decommissioned on February 1, 2023, at which point you will be redirected to the Highmark Provider Resource Center (PRC). Despite this change, you will still be able to access several tools and pages on the legacy website. Here, you can find out which content will be remaining and where to find it.
  • Credentialing and Enumeration for Nurse Practitioners and Certified Registered Nurse Anesthetists
    Beginning January 1, nurse practitioners will have the option to be fully credentialed as a primary care provider (PCP), specialist, or enumerated in either role. Certified registered nurse anesthetists will have to option to credential as a specialist or be enumerated in the reimbursement system only. In this article, you can find information on how to credential and enumerate.