Highmark Delaware Prior Authorization Lookup
Latest Highmark Delaware prior authorization updates3
- Prior AuthReimbursement/Payment PolicyEff. 2025-10-01Highmark List of Procedures/IDME Requiring Authorization (eviCore program mappings)Lists eviCore program mappings and code-level prior authorization requirements (including Genetic Testing and Radiation Oncology notice) for Highmark Delaware commercial and Medicare Advantage lines of business; includes provider verification methods and an effective date of 10/1/2025.All Highmark Delaware updates
- Prior AuthClinical/Medical PolicyOutpatient Medical Injectable Infliximab Authorization (including biosimilars) - Coverage CriteriaForm and requirements for prior authorization of outpatient medical benefit infliximab (including biosimilars) for Highmark Delaware members; intended for prescribing clinicians, infusion providers, and billing offices requesting authorization.All Highmark Delaware updates
- Prior AuthClinical/Medical PolicyPreferred Products for Medicare Advantage — Preferred and Non‑Preferred Drug Listings (Medicare Advantage)Lists Highmark Delaware's preferred and non-preferred drugs (including HCPCS/J-codes and biosimilars) for Medicare Advantage products and notes that preferred product status is used as a utilization management tool consistent with CMS guidance. Affects providers submitting claims or requesting prior authorization for Medicare Advantage members.All Highmark Delaware updates
Tool Description
Search Highmark Delawareprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Prior Authorization by Payer
Go deeper
Explore OpenPayer Data
Prior auth requirements change all the time. Keep up with every payer policy update in the live policy feed, or browse payers with prior authorization policies.
Toolbox
More OpenPayer Tools
- Billing Code LookupSearch CPT, HCPCS, J-codes, DRG, and dental codes by number or procedure name.
- Healthcare Provider & Facility LookupFind hospitals and healthcare facilities by name, taxonomy, facility type, ownership, or state.
- Health Insurance Payer LookupSearch national health insurance payers and health plans by name and state presence.
- Provider Taxonomy Code LookupSearch NUCC taxonomy codes by code, specialty, grouping, or classification.
- CPT Modifier LookupSearch CPT modifiers by code or name — descriptions, when to use them, and payer policy context.
- Timely Filing LookupFind payer timely filing policies: claim deadlines, corrected claim windows, and appeal timeframes.
- Coverage Criteria LookupSearch payer coverage criteria and medical necessity requirements by drug, procedure, or payer.
- Payer Contact DirectoryClaims, prior authorization, provider services, and appeals contacts for health insurance payers.
Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.