Highmark has updated its provider credentialing rights policy, effective April 2017. Physicians and other practitioners now have the opportunity to review information submitted during the credentialing or recredentialing process.
Highmark offers providers the ability to view network status and effective dates via the Provider File Management selection in NaviNet.® You can also use Navinet to make real-time demographic changes, add and terminate providers, request credentialing, and view credentialing specialist contact information.
Practitioners can also request information from outside sources with the exception of references, recommendations, or other peer review protected information and any other data that is prohibited from being disclosed by law. Requests can be submitted in writing, either by fax or mail:
Highmark Provider Information Management (PIM)
P.O. Box 898842
Camp Hill, PA 17089-8842
Within 30 calendar days, Highmark will then mail the requested information in an envelope marked "Personal and Confidential." A copy of the communication will also be kept in the practitioner's credentialing file.
Access the Highmark Blue Shield Office Manual here to learn more about the changes, including instructions on how to correct erroneous information.