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.