Highmark: New Precertification Requirements for Out-of-area Participating Facilities

Highmark has recently send letters and contract riders to groups notifying them of a change to the out-of-area participating provider precertification requirements, effective July 1, 2014.

The letter explains that the precertification responsibility for admission to an out-of-area participating facility is the responsibility of the provider, not the member.  The notice includes a reminder that costs for any admissions determined to be not medically necessary and appropriate will continue to be the responsibility of the member.

Updated benefit booklets and insert on new requirement are viewable through the member portal.


The information provided herein is intended solely for the use of our clients. You may not display, reproduce, copy, modify, license, sell or disseminate in any manner any information included herein, without the express permission of the Publisher or Publishers of articles within.

The information provided is for informational purposes only and does not constitute legal advice. The information above contains only a summary of the applicable legal provisions and does not purport to cover every aspect of any particular law, regulation or requirement. Depending on the specific facts of any situation, there may be additional or different requirements. This is to be used only as a guide and not as a definitive description of your compliance obligations.