What types of policy changes does Highmark issue?

Highmark regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Highmark update its policies?

Highmark typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Highmark policy changes are tracked here?

This page currently tracks 50 documented Highmark policy changes. New items are added as they are identified.

What should I do when Highmark changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

Highmark Policy Changes 2026 | Prior Auth & Coverage Updates

Highmark Policy Changes & Prior Auth Updates

We track 50 documented policy changes from Highmark across CPA, DE, MO, NE, NENY and 5 more states. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Highmark notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new Highmark updates automatically.

Medium impact

Credentialing Update: Transition to CertifyOS Portal Continues

Highmark·Effective Aug 31, 2026

Highmark is transitioning provider credentialing to the CertifyOS portal for NY, PA, and WV providers effective August 31, 2026. Providers in these states will no longer use the Initial Credentialing Prerequisites form on the Provider Resource Center (PRC) and instead will access CertifyOS to create accounts, add practitioners/facilities, submit applications, and track status. Delaware providers remain on the existing credentialing forms until a later date. Critical reminder: credentialing approval does NOT equal readiness to bill—providers must complete contracting and execute all agreements before billing begins.

Retrospective Auth Requests Must Be Submitted Within Two Years

Highmark’s Telehealth Policy Will Be Updated on Sept. 1

Updated: Corrected Claims Must Be Filed Within 15 Months of Original Claim Finalization Date

HealthHelp Transition: Sign Up for Molecular Lab Prior Auth Training

Prevent Claim Denials: NY Providers Must Transition to Highmark-EDI by Sept. 30

HealthHelp to Manage Molecular Lab Prior Authorization

Reimbursement Update: Massage Therapy CPT Code 97124

Highmark to Perform Hospital OPPS Claim Reviews

Maternity Billing Changes for 2027

How to Obtain Credentialing with Highmark Using the CertifyOS Platform

Credentialing Update: Transition to CertifyOS Portal Continues

Technical Coding Alignment for Prior Auth Processing of Select MIDs

Corrected Claims in New York Must Be Filed Within 15 Months of Original Claim Finalization Date

Medical Review Committee 2027-28: Application Deadline Extended

Introducing Practice Performance Insights: Key Performance Metric Tool

Update: Expanded List of Non-Specific Codes Subject to Additional Review

Upcoming Fee Schedule Changes, Including Highmark’s Annual Adjustment

Mid-Year Preventive Schedule Update: MEB Screening and RSV Vaccine

Prior Authorization Updates: Two Additions and 90+ Removals

Avoid This Error When Submitting MSK Authorization Requests

Evolent Transition: Sign Up for Oncology Prior Auth Training

MSK Authorization Transition on May 1; Your Questions Answered

MSK Codes Being Added to Site of Care Policy on May 1

Reminder: Register For Evolent Oncology Prior Authorization Training

MSK Authorization Will Transition from eviCore to Highmark on May 1, 2026

Prior Authorization Changes to Oncology-related Codes

Medically Unlikely Edits: Providers Must Bill for Individual Dates, Instead of Span Dating

New and Updated Reimbursement Policies – February 2026

Important Claim Updates for New York Providers

Reminder: Changes Coming in 2026

Reimbursement Policy Changes for Billing of Skin Substitutes

Upcoming Site of Care Program Impacts Certain Outpatient Surgeries

Reminder: Annual Medicare Compliance Training

Organizational Providers: Change of Ownership Reminder

Issue Identified: BlueCard Claim Status Not Available in Availity

Fast, Easy, and Secure: Submit Claim Attachments Electronically

Prior Authorization Submission Help and Tips

Latest Edition of MCG Care Guidelines

Annual Chlamydia Screening for PA CHIP Members Age 16+

Best Coding Practices: Migraines

BH Outpatient Update: Electronic Auth Extensions Now Available

Pricing Calculated to Five Decimal Points for Certain Drug Codes

Medical Injectable Drug Crysvita to Require Prior Authorization

Medicare GLP-1 Bridge: New CMS Program for Certain Weight-Loss Drugs

New Audit Requirements for Million-Dollar Claims

Best Coding Practices: Major Depressive Disorder

New and Updated Reimbursement Policies – May 2026

Follow Proper Procedures for Paper Claims; Noncompliant Forms Will Be Returned

Evolent Oncology Auth Submissions: Managing the New Process

Issue Identified and Corrected: Psychotherapy Procedure Code 90834