CommercialPrior AuthHigh impact
HealthHelp Transition: Training Sign-Up, Prior Auth Code List, and NY Update
Highmark·DE, PA, WV, NY · Genetics·Prior Authorization
Effective date
Oct 1, 2026
We identified it
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.
Action Required
By September 2026: Billing team and providers must register for and complete HealthHelp training sessions (both sessions available; attendance flexibility provided). Before October 1, 2026: Review the HealthHelp prior authorization code list and FAQs on the HealthHelp Provider Page. Update 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. Update EMR/billing software to reflect new authorization process. Note: This applies to commercial fully insured, Medicare Advantage, ACA, self-funded ASO (DE, PA, WV only), and Pennsylvania CHIP plans. New York transition date is pending and will be communicated separately. Failure to transition to HealthHelp by October 1 will result in delays in authorization processing and potential claim denials.