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HighmarkCommercial · Prior Auth · Prior Authorization · DE, PA, WV, NY · GeneticsHigh impact

HealthHelp Transition: Training Sign-Up, Prior Auth Code List, and NY Update

Effective date
Oct 1, 2026
Identified
Aug 29, 2026

Summary

Highmark is transitioning genetic/molecular lab testing prior authorization reviews to HealthHelp (a specialty benefit management company) effective October 1, 2026, for Delaware, Pennsylvania, and West Virginia providers. New York providers will transition later in the year. Providers must complete training in September and review the HealthHelp prior authorization code list before the October 1 deadline to ensure smooth claims processing.

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What to do

Action · 6 steps
01By September 2026: Billing team and providers must register for and complete HealthHelp training sessions (both sessions available; attendance flexibility provided).
02Before October 1, 2026: Review the HealthHelp prior authorization code list and FAQs on the HealthHelp Provider Page.
03Update billing workflows to route all genetic/molecular lab testing prior authorization requests through HealthHelp instead of internal Highmark processes for DE, PA, and WV members.
04Update EMR/billing software to reflect new authorization process.
05Note: This applies to commercial fully insured, Medicare Advantage, ACA, self-funded ASO (DE, PA, WV only), and Pennsylvania CHIP plans.
06New York transition date is pending and will be communicated separately.
If missed: Failure to transition to HealthHelp by October 1 will result in delays in authorization processing and potential claim denials.

Original notice

HealthHelp Transition: Training Sign-Up, Prior Auth Code List, and NY Update
providers.highmark.com · Always check the source before changing claims.
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Related changes

See all Highmark changes →
Genetic/Molecular Lab Testing to Require Authorization in NY Starting Nov. 1HighEffective Nov 1, 2026 · Provider BulletinHealthHelp Transition: Sign Up for Molecular Lab Prior Auth TrainingHighEffective Oct 1, 2026 · Prior AuthorizationHealthHelp to Manage Molecular Lab Prior AuthorizationHighEffective Oct 1, 2026 · Provider BulletinBrowse every Highmark change in the policy list

Related policy hubs

Highmark policiesDE policy changesPA policy changesWV policy changesNY policy changesGenetics

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