Highmark Provider Resources

As of 1/01/25, EviCore by Evernorth will no longer provide authorization for Radiology, Cardiovascular, and Musculoskeletal cases for Highmark Health Options. Should you have any questions, please contact Highmark Health Options. 

In compliance with West Virginia Senate Bill 267, all prior authorization requests for West Virginia members receiving services in the state of West Virginia must be submitted via the health plan online portal or at EviCore.com.
 

CARDIOLOGY AND RADIOLOGY (OUT OF AREA and OUT OF NETWORK) EXPANSION EviCore  is pleased to announce its continued partnership with Highmark to provide services for members enrolled in Individual, Commercial and Medicare markets. Highmark will require prior authorization from EviCore for membership delegated for out of area and out of network cardiology and radiology services on dates of service August 1, 2021 and beyond. If services are performed without prior authorization, they will be denied 

EviCore by Evernorth is no longer managing Radiology or Cardiovascular prior authorization requests for Highmark Western New York and Highmark Northeastern New York members enrolled in Individual, Commercial and Medicare markets for dates of service after December 31, 2023. All requests for dates of service on or before December 31, 2023 will be handled by EviCore, all retro authorization requests and requests for dates of services on or after January 1, 2024 will be managed by Highmark. For any questions please contact Highmark using the phone number on the back of the member’s ID card