Highmark West Virginia Prior Authorization Lookup
Latest Highmark West Virginia prior authorization updates6
- Prior AuthReimbursement/Payment PolicyEff. 2026-02-01FEP list of procedures and durable medical equipment requiring prior authorizationA fee-for-service (FEP) list of procedures and durable medical equipment that require prior authorization for enrolled members in DE, NY, PA, and WV; affects providers submitting authorization requests for those enrollment codes.All Highmark West Virginia updates
- Prior AuthReimbursement/Payment PolicyEff. 2025-10-01Highmark Prior Authorization / Managed Procedure & DME Listing (Effective 10/1/2025)This document describes eviCore's management/postponement of prior authorization responsibilities for Genetic Testing and Radiation Oncology for Highmark West Virginia commercial and Medicare Advantage lines of business and provides a large listing of reconstructive/cosmetic procedure codes and modalities that are tracked for authorization/Gold Card eligibility. It affects Highmark West Virginia providers submitting authorizations for affected members.All Highmark West Virginia updates
- Prior AuthClinical/Medical PolicyDupixent (dupilumab) prior authorization request - coverage criteriaThis form governs prior authorization requests for Dupixent (dupilumab) across multiple labeled indications and is intended for providers requesting coverage for Highmark West Virginia members.All Highmark West Virginia updates
- Prior AuthClinical/Medical PolicyMedication prior authorization form (Contrave)Form and instructions to request prior authorization for Contrave (naltrexone/bupropion) for Highmark West Virginia members; used by prescribing providers to submit clinical and administrative information to support coverage.All Highmark West Virginia updates
- Prior AuthClinical/Medical PolicyPreferred Oncology Products (biosimilars and supportive care agents) — Coverage CriteriaDefines Highmark West Virginia preferred and non-preferred oncology products (including biosimilars and supportive care agents) and describes prior authorization and therapeutic trial expectations for non-preferred requests; applies to professional and facility claims.All Highmark West Virginia updates
- Prior AuthClinical/Medical PolicyVyleesi (bremelanotide) prior authorization form coverage criteriaThis document is a prior authorization request form for Vyleesi (bremelanotide) for treatment of hypoactive sexual desire disorder (HSDD) in premenopausal females; it governs information providers must supply to request initial or reauthorization of therapy from Highmark West Virginia.All Highmark West Virginia updates
Tool Description
Search Highmark West Virginiaprior 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.