CommercialPrior AuthHigh impact
Retrospective Auth Requests Must Be Submitted Within Two Years
Highmark·Provider Bulletin
Effective date
Aug 1, 2026
We identified it
Apr 24, 2026
Summary
Highmark now requires all retrospective authorization requests to be submitted within two years of the date of service, effective August 1, 2026. Claims submitted for retrospective review after the two-year deadline will not be paid, and network providers cannot bill members for these services.
Action Required
Before August 1, 2026: Billing team must implement tracking system to monitor all services requiring retrospective authorization and ensure requests are submitted within two years of service date. Update billing workflows to flag claims approaching the two-year deadline. Train staff on new timeline requirements. Services submitted after two years will receive no payment and cannot be billed to patients.