All PlansPrior AuthHigh impact
MSK Authorization Transition on May 1; Your Questions Answered
Highmark·PA, DE, NY, WV · Orthopedics, Pain Management, Neurosurgery +1 more·Provider Bulletin
Effective date
May 1, 2026
We identified it
Apr 17, 2026
Summary
Effective May 1, 2026, Highmark will directly manage all musculoskeletal (MSK) and interventional pain management (IPM) prior authorization requests, transitioning away from eviCore. Over 100 MSK surgical procedure codes are being added to site of care clinical review requirements as part of this transition.
Action Required
By May 1, 2026: Billing team must redirect all MSK and IPM prior authorization requests from eviCore to Highmark's authorization system. Update billing workflows and staff training to use Highmark's authorization portal instead of eviCore for all services with dates of service on or after May 1. Review the 100+ MSK surgical codes being added to site of care requirements and update authorization checklists accordingly. Note that existing eviCore authorizations spanning past May 1 will still be honored.