Highmark's medical policy guidelines address both clinical and claim payment reimbursement issues. These guidelines address hundreds of medical issues, including diagnostic and therapeutic procedures, injectable drugs, and durable medical equipment. Some policies address procedures and services that are considered to be part of another procedure or service and, as such, are not separately payable. Many of these clinical and reimbursement guidelines are automated in our claims processing system.
You may search for topics by Keyword, Procedure Code or Policy Bulletin Number.
Medical policy guidelines for all of Highmark's medical-surgical products, including managed care.
Medical policy information that is appropriate for Medicare Advantage in West Virginia products.
Highmark serves the entire state of West Virginia as Highmark Blue Cross Blue Shield. Highmark Senior Solutions Company ("HSSC") provides Medicare Advantage products and services in West Virginia.
