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  2. Provider Portal and Prior Authorizations
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  3. Provider Portal and Prior Authorizations

Provider Portal and Prior Authorizations

Mandatory Portal Submission for Highmark Health Options West Virginia (HHO WV) Authorization Requests:

Effective April 1, 2026, all authorization requests for HHO WV Medicaid and CHIP members, including those managed by HealthHelp, must be submitted exclusively through the designated provider portals.

Authorization requests from participating (PAR) providers received via any other method will be returned, requiring resubmission through the portal. This change is occurring to comply with WV Code § 9-5-32, which mandates the use of an electronic portal for authorization requests to Managed Care Organizations.

Exceptions:

  • Non-participating providers are exempt from mandatory portal submission.
  • HHO Duals (Medicare) members are exempt from mandatory portal submission; however, we highly encourage portal submission for quicker response time.
  • Urgent requests in emergency situations.
  • Important Note on Exceptions for PAR Providers: Even when an exception applies, PAR providers submitting outside the portal will receive a reminder to utilize the portal for all future authorization requests.

 

NaviNet Provider Portal

Highmark Health Options West Virginia utilizes NaviNet as our provider portal. You can use NaviNet to verify member eligibility and benefits information, conduct claims search inquiries, connect to the appropriate prior authorization portals, and more.

You can reference our instructions to create your Highmark Health Options NaviNet account for help integrating your existing account or registering for a new account.

Additionally, you can reference the NaviNet and Provider Portal Training Guide to learn how you can use the various self-service functions within our provider portal.

GuidingCare Authorization Portal

Participating providers must submit authorizations electronically through GuidingCare, via NaviNet for all services requiring authorization from our Utilization Management Department. Reference the GuidingCare User Guide to learn about the portal’s member search functionality, member eligibility, authorization requests, and more.

HealthHelp Authorization Portal

Prior authorization requests for the following services must be submitted through HealthHelp:

  • Musculoskeletal: spine, knee, hip surgeries
  • Interventional Pain Management Services
  • Trigger Point Injections
  • Outpatient Diagnostic Imaging Services: CT scans, PET scans, MRIs, etc.
  • Physical Therapy/Speech Therapy/Occupational Therapy
  • Cardiology
  • Sleep Studies (members age 18 and older)
  • Radiation Oncology (members age 18 and older)

To request prior authorizations and check status in HealthHelp, follow the instructions for HealthHelp: Single Sign-On Capabilities through the NaviNet provider portal.

Additionally, HealthHelp offers training webinars.

Prior Authorization Code Lookup

Find out if prior authorization from Highmark Health Options is required for medical procedures and services by using the Prior Authorization Code Lookup.