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Provider Resources & Tools

Caring for our members is your top priority and we are committed to helping you easily access the resources and tools you need. Blue Cross of Northeastern Pennsylvania is now Highmark Blue Cross Blue Shield. Our members' health insurance plans will continue to be offered by Blue Cross of Northeastern Pennsylvania until they renew for 2016. Find forms, manuals, policies and the latest information to help you provide the best care possible. Check out valuable Health Care Reform tools and resources to help you and your patients prepare.

Medical Management

Our goal is to work with you to provide our members appropriate care at the right time and in the right setting. Access prior approval requirements, medical policies and clinical guidelines.

Quality Management

Providing quality care for your patients starts with the latest information available to you. Access quality management flow charts, forms and practice guidelines that provide procedures and methodologies determined to be the most recognized practices to follow in treatment and managing specific diseases and illness.

Health & Wellness

Blue Cross of Northeastern Pennsylvania offers Blue Health SolutionsSM to help support your care. Your patients with BlueCare® coverage have access to Blue Health Solutions, a unique program that helps them better manage and take control of their health.

Medicare Advantage

Information about Medicare Advantage is available to help your patients receive the care they need. Find information mailings, reference materials, electronic tools and programs on Medicare Advantage to help you serve your members.

Ebola Virus Information for Providers:

Key information can be found on the Ebola virus at:

Among other important information these links contain recommendations for healthcare personnel and health officials who are evaluating patients for possible Ebola virus disease.