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Case Management Referrals: Caring for Members with Complex Conditions
Highmark·Provider Bulletin
Effective date
May 7, 2026
We identified it
May 7, 2026
Summary
Highmark has introduced a new streamlined process for providers to refer members with complex conditions and chronic illnesses to case management services through Availity Essentials. This allows providers to connect patients to clinical support programs more efficiently.
Action Required
Providers caring for members with chronic conditions and complex medical needs should familiarize themselves with the new case management referral process in Availity. Access through Payer Spaces > Predictal > Case Management Referral to submit referrals for appropriate patients who could benefit from coordinated clinical support.