MedicaidCoverageMedium impact
Annual Chlamydia Screening for PA CHIP Members Age 16+
Highmark·PA · OB-GYN, Family Medicine, Pediatrics +2 more·Provider Bulletin
Effective date
Jul 22, 2026
We identified it
Jul 23, 2026
Summary
Highmark PA CHIP now requires annual chlamydia screening for sexually active females ages 16+. This screening is covered at no cost as preventive care and is part of NCQA HEDIS performance metrics. Providers should implement annual screening protocols during well-child visits and use trauma-informed, patient-centered approaches when discussing sexual health.
Action Required
Effective immediately: Providers in Highmark PA CHIP regions (WPA/NEPA and CPA/SEPA) must implement annual chlamydia screening for all sexually active females ages 16+. Billing team must: (1) Ensure chlamydia screening claims are submitted with no patient cost-share, coding as preventive care; (2) Update encounter templates to prompt providers to document sexual activity status and screening discussion; (3) Coordinate with clinical staff to identify sexually active patients ages 16+ during well-child visits. This is a HEDIS performance measure, so accurate documentation and claim submission are essential for quality metric reporting. Failure to offer/document screening may negatively impact plan quality scores.