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Introducing Practice Performance Insights: Key Performance Metric Tool
Act
by Jul 27, 2026
Effective date
Jul 27, 2026
Identified
Jul 28, 2026
Summary
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.
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What to do
by Jul 27, 2026 · 7 steps
01Billing and clinical teams must prepare for quarterly performance monitoring.
02Providers with 50+ commercial and/or 50+ Medicare Advantage attributed Highmark members should access the Practice Performance Insights tool via Availity Essentials to review initial performance scores on Quality, Appropriateness of Care, Documentation Quality, and Cost Efficiency.
03Identify current performance gaps relative to peer benchmarks and develop remediation plans.
04Ensure documentation practices meet Highmark's quality standards to avoid negative performance ratings.
05Monitor quarterly updates distributed through Availity starting July 27, 2026.
06Ongoing: Track performance metrics throughout 2027 and beyond, as Highmark will conduct annual network evaluation and may terminate high-performance network participation for practices consistently underperforming versus peers.
07Contact Highmark Provider Services for access support: DE/PA/WV 888-601-7089, NY 888-601-8785, or visit providers.highmark.com/insights.
Original notice
Introducing Practice Performance Insights: Key Performance Metric Tool
providers.highmark.com · Always check the source before changing claims.