If you have questions or comments on medical policy issues, please complete the form at this LINK.

The Medical Policy Department, in collaboration with physician specialists, develop and maintain medical necessity and coverage guidelines for all medical-surgical products for the Commercial and Medicare Advantage lines of business. These guidelines address medical services, including diagnostic and therapeutic procedures, injectable drugs, and durable medical equipment. We review our existing medical policies to reflect scientific-based evidence and the current standard-of-care. Procedure codes and diagnosis codes applied to each policy are integrated into the claims processing system which ensures accurate administration of member benefits.

The Medical Policy Department also manages the following:

• Diagnosis code maintenance in HCCS (HW716 Form)
• Diagnosis code grouper management (HW716 Form)

Submit inquiries to Reimbursement Policy and Coding for the following code types (RP&C Link):

• CPT Procedure and Modifier Codes
• HCPCS Alphanumeric Procedure and Modifier Codes
• CDT Dental Procedure and Modifier Codes
• ICD-10 PCS Procedure Codes
• UB Revenue and Modifier Codes

For questions on claims, benefits and eligibility, please contact Provider_Service_Global_Supervisors@highmark.com

If you have questions or comments related to medical policy issues or new technology submissions, please complete a Medical Policy Inquiry Request form located in the Medical Policy SharePoint site using the icon below.