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HighmarkAll Plans · Prior Auth · Provider Bulletin · PA, NY, WV, DEHigh impact

Electronic Medical Record Systems: Enhancing Data Access and Streamlining Prior Authorizations

Act
by Jan 1, 2027
Effective date
Jan 1, 2027
Identified
Oct 17, 2026

Summary

Highmark is implementing new EMR system capabilities effective January 1, 2027, to streamline prior authorization workflows through CMS-mandated interoperability APIs. Providers will be able to check authorization needs, retrieve documentation requirements, and submit/track prior authorizations directly within compatible EMR systems. Additionally, providers gain secure access to patient Highmark health records including claims, encounter data, and clinical information through a new Provider Access API.

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What to do

by Jan 1, 2027 · 7 steps
01Providers and technical teams must work with their EMR vendors to prepare for integration with Highmark's FHIR-based APIs.
02Billing teams should.
03Monitor the Highmark Provider Resource Center for onboarding and implementation guides.
04Coordinate with internal IT and EMR vendors to assess which of the four key APIs apply to your practice (Coverage Requirements Discovery, Document Templates and Rules, Prior Authorization Support, and Provider Access API).
05Plan workflow updates to leverage automated prior authorization checking at point of care.
06Familiarize staff with the new myHighmark.com member portal data-sharing controls, as patient permissions will affect data access.
07Providers should check the forthcoming Highmark Developer Portal (under construction) for technical specifications and implementation timelines.
If missed: Failure to integrate may result in delayed or manual prior authorization processing compared to competitors with integrated EMR systems.

Original notice

Electronic Medical Record Systems: Enhancing Data Access and Streamlining Prior Authorizations
providers.highmark.com · Always check the source before changing claims.
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