Provider Resources and Support

Where do I send claims?

Please reference the back of the member’s ID card for the most accurate information. Claims should be submitted to the local Blue Cross and/or Blue Shield Plan

Where do I submit a prior authorization?

PAs are handled through American Health Holding (AHH). For faster service, call the number on the back of the member’s ID card.

How to submit a PA request to AHH:

• Things to know before submitting:
  • PA list for AHH
    • Important: If a service/procedure is not on this list, then that service/procedure does NOT require a prior authorization.
  • There is not an option to upload clinicals via the portal
    • Please fax clinicals as soon as possible
  • Please include the reference number if you have one but you do not need to include the member’s insurance card
  • At times, colored photos may be required. The prior auth nurse will reach out to you in these cases
• Online portal: www.collectivehealth.getprecert.com
• Fax: 844-354-0205
  • Clinicals only
• Phone: Please call 877-599-2911
  • Call for faster service

Required documentation for Prior Authorization requests to American Health Holding:

• Member ID, Group Number, Member Name, Employer, Member DOB, Network, Member Address
• Patient Name, Patient DOB, Relationship to Member
• Case Type (Inpatient or Outpatient), Urgency (Elective or Emergent)
• Admission Date/Estimated Date of Confinement (EDC), Procedure Date
• Facility Name, Address, Phone Number, and National Provider Identifier (NPI) or Taxpayer Identification Number (TIN)
• Provider Name, Address, Phone Number, Specialty, and National Provider Identifier (NPI) or Taxpayer Identification Number (TIN)
• Diagnosis Code(s) (i.e. ICD-10 code(s))
• Procedure Code(s) (i.e. CPT/HCPCS code(s))
• Priority of the PA (Urgent/Standard)

Where can I confirm what needs a PA?

A full list of services that require PAs can be found here

Highmark Medical Policies

This list may be subject to exclusions based on benefit and contract terms.

• All Inpatient Hospital Admissions, including:
  • Observation stays exceeding 47 hours
  • Acute Inpatient hospital admissions, including Obstetric admissions that exceed federal mandate (2 days for Vaginal, 4 days for C-section births)
  • Long-Term Acute hospital admissions
  • Inpatient Mental Health and/or Substance Use Disorder admissions
  • Inpatient Rehabilitation facility admissions 
  • Residential Treatment Facility admissions
  • Skilled Nursing Facility (SNF) admissions
• Any of the procedures/services captured here

For required documentation and clinical criteria, please refer to any of the following resources:

• Call the Prior Authorization phone number on the back of the patient’s member ID card
• Highmark Medical Policy – Please only reference policies, do not reference PA lists

Prior authorization determination appeals should be submitted to AHH directly. 

How to submit a PA determination appeal to AHH:

Appeals can be submitted one of the following ways:

• Fax Number: 844-354-0205
• Email: ahh_appeals@ahhinc.com

Required documentation for Prior Authorization appeal requests to American Health Holding:

• Appointment of Authorized Representative Form (Form) — required if your are appealing on the patient’s behalf
• Request for Internal Appeal Form (Form) — the formal appeal form
• Supporting documentation — any documents that support the appeal, such as relevant excerpts of medical records

Submission deadlines:

• Must be submitted within 180 days of receiving the adverse benefit determination

For any questions related to prior authorizations, please call the number on the back of the member’s ID card. Otherwise, please call (877) 599-2911 and select “Medical Authorizations”.