Highmark Prior Authorization
Overview
Highmark Blue Cross Blue Shield operates in Pennsylvania, West Virginia, and Delaware as a licensee of the Blue Cross Blue Shield Association. Highmark processes prior authorization requests within 1-5 business days for standard approvals and 24 hours for urgent cases. Specialty referrals, advanced imaging (MRI, CT, PET), inpatient admissions, and certain procedures require pre-authorization. Submission through the provider portal at highmarkbcbs.com ensures faster processing and real-time authorization confirmation.
Key Requirements
- Verify Member's State & Plan: Highmark operates separate plans in Pennsylvania, West Virginia, and Delaware. Authorization requirements vary by state and plan type. Confirm the member's specific plan.
- Authorization List: Not all services require prior authorization. Check Highmark's provider portal at highmarkbcbs.com or your contract for the complete authorization list by plan.
- Required Documentation: Include diagnosis codes, procedure codes, treatment plan, medical necessity statement, and date of service. Incomplete submissions delay approval.
- Submission Channel: Online portal submission through highmarkbcbs.com is fastest (1-5 business days). Phone and fax submissions are available but take longer.
Approval Timeline & Process
Highmark processes standard prior authorization requests within 1-5 business days through the online portal. Expedited requests (medically urgent cases) receive approval within 24 hours with documented clinical justification. Concurrent authorization submitted during inpatient admission is resolved within 24 hours. Emergency services are approved retrospectively after treatment and do not require pre-authorization. Contact Highmark's medical management team directly for urgent cases to expedite approval.
Common Authorization Categories
| Service Category | Typical Authorization Status | Submission Method |
|---|---|---|
| Specialty Referrals | Requires authorization | Online portal or phone |
| Imaging (MRI, CT, PET) | Requires authorization | Online portal or phone |
| Inpatient Admission | Requires authorization | Online portal or phone |
| Durable Medical Equipment | Requires authorization (plan-dependent) | Online portal or phone |
Provider Portal Access
Highmark's provider portal at highmarkbcbs.com offers real-time authorization submission, claim status tracking, eligibility verification, and plan documentation access. Registered providers can submit authorizations online and receive immediate confirmation. Portal access requires provider enrollment with Highmark. Contact Highmark provider relations if you need enrollment or portal access support.
Common Questions
Does Highmark require prior authorization for specialty referrals?
Yes. Most Highmark BCBS plans require prior authorization for specialty referrals. Check your specific plan's authorization list through highmarkbcbs.com.
How long does Highmark take to approve prior authorization?
Standard: 1-5 business days (online portal). Expedited: 24 hours. Concurrent (during admission): 24 hours.
What is the Highmark provider portal address?
Access Highmark BCBS resources at highmarkbcbs.com. The portal includes authorization submission, claim status, and provider documentation.
Altair checks Highmark requirements before submission . flagging missing authorizations and coding mismatches in real time. See how Altair works.
This reference is for informational purposes. Payer policies change frequently. Always verify against Highmark's current provider documentation. Last updated: 2026-03-16.