Highmark participating provider agreement form 2026

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The document is a Participating Provider Agreement with Highmark Blue Shield, outlining the terms under which a provider agrees to offer services to Blue Shield members. It details the responsibilities of the provider, including compliance with applicable laws and regulations, reporting services rendered, and accepting compensation as per the Blue Shield Regulatory Act. The agreement also specifies conditions for termination, requirements for billing and claims submission, and obligations regarding changes in membership or contractual arrangements.

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Click ‘Get Form’ to open the highmark participating provider agreement form in our editor.
Begin by filling in your main practice address, including street, city, state, and ZIP code. Ensure accuracy as this will be used for your provider record.
Next, provide your name (printed), telephone number, specialty, social security number, and Pennsylvania license number. This information is crucial for verification purposes.
If your mailing address differs from your practice address, complete that section as well. Include street, city, state, and ZIP code.
Attach a copy of your current Pennsylvania license as required. This can be done easily by uploading the document directly in our platform.
Review all entered information for accuracy before signing and dating the form at the bottom. Your signature confirms your agreement to the terms outlined.
Finally, submit the completed form by mailing it to Provider Data Services at the specified address or faxing it if applicable.

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What is EPO in Highmark?

Exclusive Provider Programs (or, Organizations) (EPO) A health care plan which provides benefits when care is received from network providers, and for emergency care when received at either network or out-of-network providers.

Are Blue Cross, Blue Shield, and Highmark the same?

Together with its Blue-branded affiliates, Highmark Inc. is collectively the fourth-largest overall Blue Cross and Blue Shield-affiliated organization in the country based on capital. Highmark Inc. is an independent licensee of the Blue Cross Blue Shield Association.

What is another name for Blue Cross Blue Shield?

Blue Cross Blue Shield Association, also known as BCBS, BCBSA, or The Blues, is a United Statesbased federation with 33 independent and locally operated BCBSA companies that provide health insurance to more than 115 million people in the U.S. as of 2022.

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What portal does Highmark use?

NaviNet Provider Portal Highmark Health Options West Virginia utilizes NaviNet as our provider portal.

How do I contact Highmark credentialing?

Practitioners should contact Highmarks Provider Data Services Department at 866-763- 3224, if they have any questions regarding the status of their credentialing/re- credentialing applications.