What types of policy changes does Highmark issue?

Highmark regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Highmark update its policies?

Highmark typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Highmark policy changes are tracked here?

This page currently tracks 50 documented Highmark policy changes. New items are added as they are identified.

What should I do when Highmark changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

PAYER POLICY CHANGES

Highmark Policy Changes & Prior Auth Updates

We track 50 documented policy changes from Highmark across DE, MO, NE, NJ, NY and 2 more states. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Highmark notice. Use the related links below to narrow results by specialty or state, or create a free alert to get new Highmark updates by email (daily or weekly, your choice, on every plan).

Highmark · Effective Dec 1, 2026High impact
Claim Adjustment Requests Must Be Filed Within 15 Months of Original Claim Finalization Date
Effective December 1, 2026, Highmark is implementing a new 15-month (455 calendar day) deadline for submitting claim adjustment requests, measured from the claim finalization date rather than receipt date. Claim adjustment requests submitted after this deadline will be automatically denied for untimely filing. This change applies to Commercial, Medicare Advantage, and Federal Employee Program (FEP) plans but excludes BlueCard Home.
Highmark · Effective Dec 1, 2026High impact
NY Providers: Sign and Return Updated Contracts by Dec. 1
Highmark is requiring all New York providers to sign and return updated Professional Agreements by December 1, 2026. Providers contracting with both Commercial and Medicare Advantage businesses must return both signed contracts (dated on or after August 1, 2026). This is a credentialing/contract compliance requirement affecting network participation.
Highmark · Effective Jan 1, 2027High impact
ValueBlue Partial Capitation Reimbursement Begins Jan. 1, 2027
Highmark ValueBlue introduces a partial capitation reimbursement model for primary care providers (PCPs) effective January 1, 2027. PCPs must enroll by December 1, 2026, to participate; those who do not enroll will face a 20% reduction in capitated codes on the community fee schedule effective April 1, 2027.
Highmark · Effective Jan 1, 2027High impact
ValueBlue Base Rates Set for 2027
Highmark is launching the ValueBlue partial capitation program for West Virginia providers effective January 1, 2027. Professional providers will receive monthly capitation payments based on 2027 base rates adjusted for patient health (MAF) and provider performance (PAF), with potential payment adjustments ranging from -20% to +40% based on quality and emergency department utilization metrics.
Highmark · Effective Jan 1, 2027High impact
ValueBlue Base Rates Set for 2027
Highmark is launching the ValueBlue partial capitation program for professional providers effective January 1, 2027, replacing traditional fee-for-service reimbursement with PMPM (per-member-per-month) base rates adjusted by member health factors and provider performance metrics. Billing teams must review 2027 base capitation rates by region and line of business, access the 2027 PAF Report, and understand that payments are retrospective and subject to quality/efficiency adjustments of up to ±40% and ±20% respectively.
Highmark · Effective Jan 1, 2027High impact
Electronic Medical Record Systems: Enhancing Data Access and Streamlining Prior Authorizations
Highmark is implementing new EMR system capabilities effective January 1, 2027, to streamline prior authorization workflows through CMS-mandated interoperability APIs. Providers will be able to check authorization needs, retrieve documentation requirements, and submit/track prior authorizations directly within compatible EMR systems. Additionally, providers gain secure access to patient Highmark health records including claims, encounter data, and clinical information through a new Provider Access API.
Highmark · Effective Jan 1, 2027High impact
ValueBlue Base Rates Set for 2027
Highmark is launching the ValueBlue partial capitation program effective January 1, 2027, establishing new base capitation rates by line of business (Commercial 18+: $4.81, Commercial under 18: $21.69, Medicare Advantage: $20.51) and introducing performance adjustment factors (PAF) for primary care providers based on quality metrics and ED utilization. Billing teams must review 2027 PAF reports, understand the new Member Adjustment Factor (MAF) structure, and prepare systems for retrospective capitation payments.
Highmark · Effective Jan 1, 2027High impact
2027 BestPractice Program Changes
Effective January 1, 2027, Highmark is rebranding the BestPractice Program to ValueBlue and updating capitation base rates and performance adjustment factors (PAF) for primary care providers. The program structure remains the same, but quality metrics are being updated and the Emergency Department Utilization metric will replace Avoidable ED Visits. The current True Performance/True Performance Lite program will sunset at year-end 2026.
Highmark · Effective Jan 1, 2027High impact
Medical Injectable Drug Program Changes in the New Year
Effective January 1, 2027, Highmark is adding 13 new drugs to its Medical Injectable Drug Program and adjusting reimbursement rates to align with average selling price (ASP) or average wholesale price (AWP) for drugs without an ASP. Billing teams must update their systems to recognize the new HCPCS codes and apply the corrected reimbursement methodology for these injectable medications.
Highmark · Effective Jan 1, 2027High impact
Medical Injectable Drug Program Changes in the New Year
Effective January 1, 2027, Highmark is adding 13 new drugs to its Medical Injectable Drug Program and adjusting reimbursement rates to align with average selling price (ASP) or average wholesale price (AWP) for drugs lacking an ASP. These drugs receive HCPCS codes and remain in the program once coded. Billing teams must update their systems to recognize these new HCPCS codes and apply the correct reimbursement methodology.
Highmark · Effective Jan 1, 2027High impact
Evolent to Manage Medical and Radiation Oncology Authorizations
Beginning January 1, 2027, Evolent will manage prior authorization reviews for medical and radiation oncology services for Highmark Commercial members in New York and ASO members in Delaware, New York, Pennsylvania, and West Virginia. Prior auth for oncology services WITH a cancer diagnosis will be managed by Evolent, while services WITHOUT a cancer diagnosis will remain with Highmark's UM team. Initial auth requests still submit through Availity, but supporting clinical documentation for Evolent reviews must be uploaded to Evolent's CarePro portal.
Highmark · Effective Jan 1, 2027High impact
Evolving Primary Care Reimbursement in 2027: Introducing ValueBlue and ValueBlue Connect
Highmark is replacing its current PCP fee-for-service and True Performance programs with two new value-based models effective January 1, 2027: ValueBlue (partial capitation with monthly payments for attributed members plus fee-for-service for preventive/wellness services) and ValueBlue Connect (incentive program rewarding quality outcomes and care coordination). This fundamentally changes how primary care providers are reimbursed, shifting from visit-based billing to population health management with stable monthly payments.
Highmark · Effective Jan 1, 2027High impact
New Claims Edit: Patient Date of Birth Validation Coming January 2027
Beginning January 2027, Highmark will implement a new claims edit that validates patient date of birth (DOB) against their records during EDI submission. Claims with DOB mismatches will be rejected and must be corrected and resubmitted. This affects all professional and facility providers submitting claims to Highmark.
Highmark · Effective Jan 1, 2027High impact
Maternity Billing Changes for 2027
Effective January 1, 2027, Highmark will implement industry-wide maternity billing changes replacing the current global maternity code with service-level coding across four phases of care (antepartum, labor management, delivery, postpartum). Antepartum and postpartum care will now use standard E/M codes instead of global codes, while new codes will be introduced for labor management, delivery, and specific obstetric procedures. Billing teams must prepare systems and workflows for this transition before the effective date.
Highmark · Effective Feb 1, 2027High impact
Action Needed: Prepare for Non-Claims and Manual Payment Changes
Effective February 1, 2027, Highmark is consolidating non-claims, manual, and value-based reimbursement payments through ECHO Health, which already processes standard claims. All these payments will route to a single electronic account, requiring providers to confirm or update bank account information by January 4, 2027, to avoid payment disruption or conversion to paper checks.
Highmark · Effective May 26, 2028High impact
CMS Requires Use of Electronic Claim Attachments by 2028
CMS approved a final HIPAA simplification rule (CMS-0053-F) requiring all providers to submit claim attachments and related signatures electronically by May 26, 2028. This mandate eliminates paper, fax, and mail submissions for supporting documentation and standardizes how insurers request additional information electronically.
Highmark · Effective Jan 1, 2027Medium impact
2027 Medicare Formulary Updates
Highmark is updating its Medicare Part D formularies effective January 1, 2027, with medication removals and new restrictions. The Fundamental Formulary is being replaced with the Performance Formulary for all affected plans. Providers and members will receive notification letters starting mid-November 2026, and coverage determination requests can be submitted beginning November 16, 2026.
Highmark · Effective Jan 1, 2027Medium impact
2027 CopayGo Expansion: Additional ASO Offerings and Fully Insured Products
Highmark is expanding its CopayGo health plan in 2027 to include new product options: ASO clients will gain access to EPO and QHDHP designs (in addition to the existing PPO), and fully insured EPO and PPO products will become available in Delaware, New York, and Pennsylvania. Providers should verify member plan types and tiered copay designations (enhanced vs. standard) through Availity, as these affect member cost-sharing but not provider reimbursement.
Highmark · Effective Jan 1, 2027Medium impact
New Copay Assistance Program for Certain Specialty Drugs Launching Jan. 1, 2027
Highmark is launching the Copay Armor Medical program on January 1, 2027, which provides copay assistance for eligible members receiving high-cost, provider-administered specialty drugs. Billing teams must be prepared to submit secondary claims to manufacturers after receiving Highmark's primary payment, with no upfront action required unless contacted by HelpScript. A complete medication list will be shared in upcoming communications.
Highmark · Effective Jan 1, 2027Medium impact
Labcorp Will Be In Network for NENY Members
Effective January 1, 2027, Labcorp will become an in-network laboratory provider for Highmark Northeastern New York (NENY) members across Commercial (Large Group, Small Group, ASO) and Individual products. Quest Diagnostics will lose preferred status but remain in-network. Medicare Advantage members already have Labcorp in-network with no changes planned for 2027.
Highmark · Effective Jan 1, 2027Medium impact
Risk Adjustment Program Compensation: Fewer Targets, Greater Opportunities
Effective January 1, 2027, Highmark is simplifying its Risk Adjustment Program by removing four high-prevalence Part D conditions (Thyroid Disorders, Anxiety/Psychiatric Disorders, Hypertension, Coronary Artery Disease) from targeting and restructuring bonus tiers for gap assessments across Medicare Advantage, D-SNP, ACA, and Medicaid plans. These changes reduce targeted conditions by approximately 50% and introduce new tiered payment thresholds to reward higher performance levels.
Highmark · Effective Jan 1, 2027Medium impact
Upcoming Changes for Highmark Condition Management Programs
Highmark is discontinuing four condition management programs effective January 1, 2027: Onduo/Verily Diabetes Management, Vida CHF/COPD Management, Well360 Behavioral Health Services, and related programs. Type 2 diabetes patients may transition to Noom Weight Management; behavioral health patients may access Spring Health. Billing teams must remove these programs as referral options from Availity Essentials by the effective date.
Highmark · Effective Jan 1, 2027Medium impact
Changes to 24/7 Coverage Requirements for Providers
Effective January 1, 2027, Highmark is removing 24/7 coverage verification from the credentialing process but maintaining the 24/7 after-hours coverage requirement for most providers. A new random monthly verification process will replace the old credentialing-based verification, with 100 practices sampled each month. Specific specialties (audiologists, dieticians, physical therapists, psychologists performing only testing/evals, etc.) are now exempt from this requirement.
Highmark · Effective Jan 1, 2027Medium impact
Are You Eligible for High-Performance Networks?
Highmark is implementing a High-Performance Network eligibility evaluation based on Practice Performance Insights metrics (quality, care appropriateness, documentation quality, and cost efficiency). Practices that do not meet performance thresholds relative to peers may lose eligibility to participate in these networks. Network participation changes for 2027 will be communicated next month, and practices should review their scorecards now to identify improvement opportunities.
Highmark · Effective Jan 1, 2027Medium impact
CPA: Choice Blue Going Away – Starting Jan. 1, 2027
Highmark is discontinuing the Choice Blue product in nine counties in Central Pennsylvania (CPA) effective January 1, 2027. Existing members will transition at their 2027 benefit renewal and do not need to take action now. Billing teams should prepare for member migrations to alternative Highmark plans, particularly Performance Flex Blue.
Highmark · Effective Jan 31, 2027Medium impact
Prior Auth Letters Going Digital in January 2027
Highmark will transition prior authorization determination letters from mailed format to digital delivery through the Availity Essentials Digital Correspondence Hub beginning in late January 2027. All providers are automatically enrolled; providers can opt out via Availity account settings. The authorization submission process and auth status checking remain unchanged.
Highmark · Effective Feb 1, 2027Medium impact
Avalon to Manage Post-Service Reviews for Non-Molecular Lab Claims
Effective February 1, 2027, Highmark will transition post-service review management for non-molecular laboratory claims from eviCore to Avalon Healthcare Solutions across Delaware, New York, Pennsylvania, and West Virginia. This change affects Commercial, Medicare Advantage, and ACA plans for routine outpatient lab testing. Billing teams must ensure accurate diagnosis and procedure coding and review Avalon's laboratory operational policies before the transition date.
Highmark · Effective Jan 1, 2027Low impact
2027 IDE Requirements Manual Available by Jan. 1
Highmark will publish an updated Interoperability and Data Exchange (IDE) Requirements Manual by January 1, 2027, on the Provider Resource Center. This manual explains which electronic medical record (EMR) solutions meet Highmark's data exchange requirements. Providers should monitor Provider News for notification when the manual is posted and review it to ensure EMR compliance.
Highmark · Effective Nov 1, 2026High impact
Genetic/Molecular Lab Testing to Require Authorization in NY Starting Nov. 1
Effective November 1, 2026, Highmark is requiring prior authorization for all genetic/molecular laboratory testing in New York through a new vendor, HealthHelp. Providers must submit authorization requests via Availity Essentials, then complete the process through HealthHelp's portal via single sign-on. This requirement applies to Commercial fully insured, Medicare Advantage, and ACA plans.
Highmark · Effective Nov 1, 2026High impact
SEPA: Self-Service Tools Required for Claim Status and Investigation – Starting Nov. 1
Effective Nov. 1, 2026, Highmark will require all providers in the Southeastern Pennsylvania (SEPA) service area to use self-service tools (Availity Essentials, Provider Chat, IVR) for claim status inquiries and claim investigations. The Highmark Provider Service Center will no longer handle these requests and will direct providers to self-service options instead.
Highmark · Effective Nov 1, 2026High impact
Highmark to Perform Hospital OPPS Claim Reviews
Starting November 1, 2026, Highmark will implement Hospital OPPS claim reviews using cost-to-charge ratios adjusted by CMS OPPS methodology, with specific exclusions for drugs/biologicals, implants, and non-separately reimbursable items governed by specific reimbursement policies (RP-019A, RP-040, RP-061, RP-080). Highmark retains authority to conduct detailed line-item reviews and chargemaster audits. The Hospital OPPS Based Payment Method Provider Training Manual will be updated to reflect these changes.
Highmark · Effective Oct 26, 2026High impact
Reimbursement Update: Massage Therapy CPT Code 97124
Effective October 26, 2026, Highmark will no longer separately reimburse CPT code 97124 (massage therapy) when billed by providers in Chiropractic, Physical Therapy, Occupational Therapy, and Physiatry specialties. Claims with this code from these specialties will be denied as non-separately reimbursed. This change applies to Commercial and Medicare Advantage plans; massage therapists billing as rendering providers are not affected.
Highmark · Effective Oct 16, 2026High impact
Reimbursement Update: CPT Code 97153 for ABA Therapy in DE, PA, and WV
Effective October 16, 2026, Highmark is reducing reimbursement rates for CPT code 97153 (Adaptive Behavior Treatment by Protocol) across Commercial PPO products in Delaware, Pennsylvania, and West Virginia. Rates are being decreased to align technician-delivered ABA services with market benchmarks and maintain appropriate differentiation from clinician-delivered services. No changes to member eligibility, medical necessity criteria, authorization requirements, or coverage policies.
Highmark · Effective Oct 5, 2026High impact
Delaware Providers: New Credentialing Portal Launches Oct. 5
Highmark Delaware is launching a new credentialing portal (CertifyOS) effective October 5, 2026, requiring all professional and facility providers to migrate credentialing activities to this platform. Providers must create accounts, maintain current CAQH ProView profiles, and understand that credentialing approval does not authorize billing without executed contracts and welcome letters.
Highmark · Effective Oct 1, 2026High impact
Guidance on New Coding and Billing Model for Maternity Care
Highmark is implementing the AMA's new maternity care coding and billing model effective January 1, 2027. Providers must transition from submitting single global maternity claims to billing for services as they occur throughout pregnancy using E/M codes with TH modifier (starting October 1, 2026) and new CPT codes (starting January 1, 2027). Billing approach during the transition period (Oct 1 - Dec 31, 2026) depends on number of antepartum visits completed.
Highmark · Effective Oct 1, 2026High impact
HealthHelp Transition: Training Sign-Up, Prior Auth Code List, and NY Update
Highmark is transitioning genetic/molecular lab testing prior authorization reviews to HealthHelp (a specialty benefit management company) effective October 1, 2026, for Delaware, Pennsylvania, and West Virginia providers. New York providers will transition later in the year. Providers must complete training in September and review the HealthHelp prior authorization code list before the October 1 deadline to ensure smooth claims processing.
Highmark · Effective Oct 1, 2026High impact
HealthHelp Transition: Sign Up for Molecular Lab Prior Auth Training
HealthHelp will replace eviCore as the prior authorization vendor for genetic/molecular lab testing across Highmark's four-state footprint effective October 1, 2026. Providers must submit initial requests via Availity Essentials, then route to HealthHelp's portal via single sign-on. New prior authorization requirements will expand significantly in New York and other regions.
Highmark · Effective Oct 1, 2026High impact
Prevent Claim Denials: NY Providers Must Transition to Highmark-EDI by Sept. 30
Highmark is discontinuing the ASK clearinghouse for electronic claims submissions in New York, effective October 1, 2026. All NY providers must transition to Highmark-EDI by September 30, 2026, or claims submitted through ASK will be denied starting October 1st.
Highmark · Effective Oct 1, 2026High impact
HealthHelp to Manage Molecular Lab Prior Authorization
Effective October 1, 2026, HealthHelp will assume management of prior authorizations for genetic and molecular lab testing across Highmark regions. In Delaware, Pennsylvania, and West Virginia, HealthHelp replaces eviCore with expanded code coverage. In New York, prior authorization requirements are being introduced for the first time for a broad range of genetic/molecular lab tests. Providers must submit requests through Availity Essentials and complete the authorization process via HealthHelp's portal with potential peer-to-peer review by genetic counselors.
Highmark · Effective Sep 30, 2026High impact
Make the Switch to Highmark-EDI for Electronic Claims by Sept. 30
Highmark is requiring all New York providers to transition from the ASK (Administrative Services of Kansas) clearinghouse to Highmark-EDI for electronic claim submissions (837s) by September 30, 2026. This is a mandatory system change affecting how claims are submitted electronically, with the added benefit of enabling batch claim attachments to be submitted electronically instead of mailed or faxed.
Highmark · Effective Sep 18, 2026High impact
Auth Submissions Temporarily Unavailable via Availity Sept. 18-21
Highmark will perform planned systems maintenance on the Availity Essentials portal from Friday, September 18 at 9 p.m. to Monday, September 21 at 6 a.m. ET. During this blackout window, providers cannot submit electronic authorization requests or view existing authorizations via Availity; urgent requests must be submitted by fax instead.
Highmark · Effective Sep 1, 2026High impact
CHIP Reproductive Services Coverage Update
Pennsylvania CHIP is implementing new billing and reimbursement requirements for abortion services effective September 1, 2026. Federally funded abortion services (rape, incest, miscarriage, or life-endangering pregnancy) continue using G7 + U1/U2/U4 modifiers with physician certification. Medically necessary abortion services not meeting federal criteria must now be billed with the U3 modifier and do not require documentation for CHIP reimbursement.
Highmark · Effective Sep 1, 2026High impact
Prior Authorization Changes: One Code Added and Nine Removed
Effective September 1, 2026, nine surgery codes (five vascular and four cardiac) will be removed from Highmark's prior authorization requirement list. Separately, effective November 1, 2026, imaging code 70471 (CT angiography of head and neck) will be added to the prior authorization requirement list across all lines of business.
Highmark · Effective Sep 1, 2026High impact
Medically Unlikely Edits Logic for Span-Dated Claims – New Implementation Date
Highmark is delaying the implementation of Medically Unlikely Edits (MUE) logic for span-dated claims from March 1, 2026, to September 1, 2026. Professional and facility providers must bill for individual dates of service instead of using span dates for claims subject to MUEs to avoid claim rejections and denials.
Highmark · Effective Sep 1, 2026High impact
Highmark’s Telehealth Policy Will Be Updated on Sept. 1
Effective Sept. 1, 2026, Highmark will restrict telehealth services to only those approved by CMS (nearly 300 CPT codes) and new AMA-approved E/M telehealth codes for audio-video (98000-98007) and audio-only (98008-98015) services. Services not on these approved lists will require in-person visits.
Highmark · Effective Sep 1, 2026High impact
Updated: Corrected Claims Must Be Filed Within 15 Months of Original Claim Finalization Date
Highmark has updated their policy requiring all corrected claims to be filed within 15 months (455 calendar days) of the original claim's finalization date, effective September 1, 2026. Corrected claims submitted after this timeframe will be denied for failing to meet timely filing requirements.
Highmark · Effective Aug 1, 2026High impact
Retrospective Auth Requests Must Be Submitted Within Two Years
Highmark now requires all retrospective authorization requests to be submitted within two years of the date of service, effective August 1, 2026. Claims submitted for retrospective review after the two-year deadline will not be paid, and network providers cannot bill members for these services.
Highmark · Effective Jul 27, 2026High impact
Introducing Practice Performance Insights: Key Performance Metric Tool
Highmark is launching Practice Performance Insights, a new quarterly performance metric tool that will evaluate provider practices on Quality, Appropriateness of Care, Documentation Quality, and Cost Efficiency. Practices that fail to meet performance thresholds relative to peers may lose eligibility in Highmark's high-performance networks, which could impact patient attribution and reimbursement opportunities.
Highmark · Effective Jul 15, 2026High impact
Update: Expanded List of Non-Specific Codes Subject to Additional Review
Highmark is expanding review of more than 100 non-specific CPT codes (not otherwise classified/specified codes) starting July 15, 2026 in DE/PA/WV and August 15, 2026 in NY. Claims with these codes will undergo additional medical necessity review and receive only 35% of billed amount if approved, unless more specific codes are available.
Highmark · Effective Jul 1, 2026High impact
Upcoming Fee Schedule Changes, Including Highmark’s Annual Adjustment
Highmark will update its standard professional fee schedules across all regions effective July 1, 2026, with additional updates to DME schedules (DE, PA, WV) on July 1st and Commercial Lab schedules (NY) on August 1st. Updated fee schedules will be available for review in Availity beginning June 1, 2026.

Payer news

Network, contract and program news from the payers we track.

Highmark · Oct 20, 2026Payer news
Enhancing Oncology Care: New Patient Cancer Support Program Launching Jan. 1
Highmark is launching a new Cancer Support program effective January 1, 2027, which includes a 24/7 nurse line staffed by Evolent clinical staff and a digital support app for eligible members.
Highmark · Oct 6, 2026Payer news
Karen Hanlon Named Chief Executive Officer and President of Highmark Health
Highmark Health announced a leadership transition effective January 1, 2027, with Karen Hanlon becoming Chief Executive Officer and President, replacing David Holmberg who will transition to Executive Chairman.
Highmark · Jun 29, 2026Payer news
New Name for Enhanced Community Care Management Program
Effective July 20, 2026, Highmark is renaming the Enhanced Community Care Management (ECCM) program to 'Well in Place.' This is a name-only change with no impact to program services, referral processes, or billing operations.
Highmark · Apr 22, 2026Payer news
Population Health: Improving Member Care
Highmark published an informational bulletin highlighting their population health approach focused on whole-person care, prevention, and coordinated care delivery.
Highmark · Mar 17, 2026Payer news
Highmark Inc. and Blue KC Receive Regulatory Approval for Affiliation
Highmark Inc. and Blue Cross and Blue Shield of Kansas City (Blue KC) have received regulatory approval to affiliate, with the official closing expected on March 31, 2026.
Highmark · Dec 18, 2025Payer news
Thank You for Your Care and Commitment
This is a year-end thank you message from Highmark highlighting recent improvements including expanded Gold Carding Program, new Communications Hub, monthly onboarding webinars, and Provider Chat for Pennsylvania.

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Claim Adjustment Requests Must Be Filed Within 15 Months of Original Claim Finalization Date

NY Providers: Sign and Return Updated Contracts by Dec. 1

ValueBlue Partial Capitation Reimbursement Begins Jan. 1, 2027

ValueBlue Base Rates Set for 2027

ValueBlue Base Rates Set for 2027

Electronic Medical Record Systems: Enhancing Data Access and Streamlining Prior Authorizations

ValueBlue Base Rates Set for 2027

2027 BestPractice Program Changes

Medical Injectable Drug Program Changes in the New Year

Medical Injectable Drug Program Changes in the New Year

Evolent to Manage Medical and Radiation Oncology Authorizations

Evolving Primary Care Reimbursement in 2027: Introducing ValueBlue and ValueBlue Connect

New Claims Edit: Patient Date of Birth Validation Coming January 2027

Maternity Billing Changes for 2027

Action Needed: Prepare for Non-Claims and Manual Payment Changes

CMS Requires Use of Electronic Claim Attachments by 2028

2027 Medicare Formulary Updates

2027 CopayGo Expansion: Additional ASO Offerings and Fully Insured Products

New Copay Assistance Program for Certain Specialty Drugs Launching Jan. 1, 2027

Labcorp Will Be In Network for NENY Members

Risk Adjustment Program Compensation: Fewer Targets, Greater Opportunities

Upcoming Changes for Highmark Condition Management Programs

Changes to 24/7 Coverage Requirements for Providers

Are You Eligible for High-Performance Networks?

CPA: Choice Blue Going Away – Starting Jan. 1, 2027

Prior Auth Letters Going Digital in January 2027

Avalon to Manage Post-Service Reviews for Non-Molecular Lab Claims

2027 IDE Requirements Manual Available by Jan. 1

Genetic/Molecular Lab Testing to Require Authorization in NY Starting Nov. 1

SEPA: Self-Service Tools Required for Claim Status and Investigation – Starting Nov. 1

Highmark to Perform Hospital OPPS Claim Reviews

Reimbursement Update: Massage Therapy CPT Code 97124

Reimbursement Update: CPT Code 97153 for ABA Therapy in DE, PA, and WV

Delaware Providers: New Credentialing Portal Launches Oct. 5

Guidance on New Coding and Billing Model for Maternity Care

HealthHelp Transition: Training Sign-Up, Prior Auth Code List, and NY Update

HealthHelp Transition: Sign Up for Molecular Lab Prior Auth Training

Prevent Claim Denials: NY Providers Must Transition to Highmark-EDI by Sept. 30

HealthHelp to Manage Molecular Lab Prior Authorization

Make the Switch to Highmark-EDI for Electronic Claims by Sept. 30

Auth Submissions Temporarily Unavailable via Availity Sept. 18-21

CHIP Reproductive Services Coverage Update

Prior Authorization Changes: One Code Added and Nine Removed

Medically Unlikely Edits Logic for Span-Dated Claims – New Implementation Date

Highmark’s Telehealth Policy Will Be Updated on Sept. 1

Updated: Corrected Claims Must Be Filed Within 15 Months of Original Claim Finalization Date

Retrospective Auth Requests Must Be Submitted Within Two Years

Introducing Practice Performance Insights: Key Performance Metric Tool

Update: Expanded List of Non-Specific Codes Subject to Additional Review

Upcoming Fee Schedule Changes, Including Highmark’s Annual Adjustment

Payer news

Enhancing Oncology Care: New Patient Cancer Support Program Launching Jan. 1 ↗

Karen Hanlon Named Chief Executive Officer and President of Highmark Health ↗

New Name for Enhanced Community Care Management Program ↗

Population Health: Improving Member Care ↗

Highmark Inc. and Blue KC Receive Regulatory Approval for Affiliation ↗

Thank You for Your Care and Commitment ↗

Enhancing Oncology Care: New Patient Cancer Support Program Launching Jan. 1

Karen Hanlon Named Chief Executive Officer and President of Highmark Health

New Name for Enhanced Community Care Management Program

Population Health: Improving Member Care

Highmark Inc. and Blue KC Receive Regulatory Approval for Affiliation

Thank You for Your Care and Commitment