All PlansAdministrativeMedium impact
Credentialing Update: Transition to CertifyOS Portal Continues
Highmark·NY, PA, WV·Provider Bulletin
Effective date
Aug 31, 2026
We identified it
Jul 28, 2026
Summary
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.
Action Required
By August 31, 2026: All professional and organizational providers in NY, PA, and WV must transition credentialing processes to the CertifyOS portal. SPECIFIC ACTIONS: (1) Providers must create CertifyOS accounts using unique email addresses for each provider entity; (2) Billing team must update internal credentialing workflows and provider instructions to direct NY/PA/WV providers to CertifyOS instead of PRC forms; (3) Establish monitoring process for CertifyOS status tracking and real-time updates; (4) CRITICAL: Billing team must NOT activate billing for any provider until BOTH credentialing approval AND fully executed contracts with effective date letters are received—credentialing approval alone does NOT authorize billing. DE providers should continue using existing forms until further notice. Failure to complete contracting before billing will result in claim denials and potential compliance issues.