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It positions the manual as a primary reference guide and describes how it aligns with provider agreements, supplements administrative requirements, and supports key workflows. 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Highmark Health Options is contracted with the State of Delaware’s Department of Health and Social Services (DHSS) to provide health services to eligible individuals. Medicaid covers 1 in 5 Americans as a state-run health insurance program. Highmark Health Options collaborates with providers and regulators to improve health outcomes, simplify the health care experience, and ensure affordability. Highmark Health Options helps more than 140,000 members receive the care and services they need to live healthier and more independent lives. Highmark Health Options members include individuals and families with low income, expecting mothers, children, and people with disabilities. Members pay nothing or very little for their health coverage.  \nHighmark Inc. (“Highmark”) was created in 1996 by the consolidation of Pennsylvania Blue Shield and Blue Cross of Western Pennsylvania. Highmark and its health insurance subsidiaries and affiliates are oneof America’s largest health insurance organizations and operate health insurance plans in Pennsylvania, Delaware, West Virginia, and New York. Highmark currently serves 6 million members. In 2011, Highmark Health, the parent company of Highmark, became one of the first health insurance companies to evolve to an integrated health and wellness company with a patient-centered care delivery system.  \nOverview  \nThis manual contains information about procedures and policies that apply to providers in the Highmark Health Options network. This manual, combined with other administrative requirements as defined or described in the applicable provider agreement, supplements and is made part of their provider agreement. This manual offers access to information on processes such as filing claims, researching patient benefits, and joining the network. It also includes important contact information on how to communicate with Highmark Health Options. This manual was designed to be a provider’s primary reference guide to  \nHighmark Health Options.  \n2022 Provider Manual | 2  \nQuick reference directory  \n| Resource | Links |\n| --- | --- |\n| Clinical Guidelines | Clinical Guidelines |\n| Critical Incidents | See a Critical Incident? Report it. |\n| Cultural Competency | Training and Toolkit |\n| Highmark Health Options\u003Cbr>Community Support | Community Support Search Tool |\n| Medical Payment and Policies | Medical, Payments Policies, and Post-Service Claim Edit Policies |\n|  |  |\n| Medical Records Audit | PCPs and Specialists\u003Cbr>Behavioral Health Providers |\n| Medication Information\u003Cbr>from Pharmacy Services | Coverage, Forms, and Prior Authorizations |\n| Procedure Codes | Fee Schedule |\n| Third Party Prior Authorizations | eviCore\u003Cbr>United Concordia Dental\u003Cbr>CoverMyMeds\u003Cbr>Davis Vision |\n| Prior Authorization Codes | Prior Authorization List (PDF) |\n| Provider Faxes | Updates and Notices |\n| Provider Contracts | HCBS Par Provider Agreement\u003Cbr>Nursing Home Par Provider Agreement\u003Cbr>Professional Par Provider Agreement |\n| Provider Forms | Forms and Reference Material |\n| Provider Resource Center | Highmark Blue Cross Blue Shield of Delaware |\n\nTable of Contents  \nHighmark Health Options contact information ..................................................... 14  \nVendor contact information ............................................................................................................. 16  \nState of Delaware contact information .................................................................. 17  \nCrisis intervention services .............................................................................................................. 17  \nProvider responsibilitie","cbCaii4TjrpiKk55","https://ap.wps.com/l/cbCaii4TjrpiKk55","pdf",11622476,145,"English","# Quick reference directory\n## Clinical Guidelines\n## Critical Incidents\n## Cultural Competency\n## Medical Payment and Policies\n## Medical Records Audit\n## Medication Information from Pharmacy Services\n## Procedure Codes\n## Third Party Prior Authorizations\n## Provider Faxes\n## Provider Contracts\n## Provider Forms\n## Provider Resource Center\n# Table of Contents\n## Highmark Health Options contact information\n## Vendor contact information\n## State of Delaware contact information\n## Crisis intervention services\n## Provider responsibilities\n## Advance directive\n## Billing responsibilities\n## Billing patients for covered services\n## No-show policy\n## Payment for services\n## Compliance requirement\n## Confidentiality and HIPAA requirement\n## Continuity and coordination of care requirements\n## Critical incidents\n## Reporting critical incidents\n## Cultural competency\n## CLAS standards\n## Emergent services","[{\"question\":\"What is the purpose of the Highmark Health Options 2023 Provider Manual?\",\"answer\":\"It provides procedures and policies for providers in the Highmark Health Options network and serves as a primary reference guide. It also supplements requirements in the applicable provider agreement and includes key contact information for communication.\"},{\"question\":\"What kinds of provider processes does the manual cover?\",\"answer\":\"The manual provides access to processes such as filing claims, researching patient benefits, and joining the network. It also supports administrative workflows tied to procedures and policies.\"},{\"question\":\"Who is the manual intended to help?\",\"answer\":\"Providers contracted within the Highmark Health Options network. The manual is meant to guide provider responsibilities, compliance expectations, and coordination of care requirements.\"}]","Provider Manual - 2023 - Highmark Health Options | PDF",1790190559,365]