Medicare AdvantageAdministrativeHigh impact
Introducing Practice Performance Insights: Key Performance Metric Tool
Highmark·DE, PA, WV, NY·Provider Bulletin
Effective date
Jul 27, 2026
We identified it
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.
Action Required
By July 27, 2026: Billing and clinical teams must prepare for quarterly performance monitoring. (1) Providers 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. (2) Identify current performance gaps relative to peer benchmarks and develop remediation plans. (3) Ensure documentation practices meet Highmark's quality standards to avoid negative performance ratings. (4) Monitor quarterly updates distributed through Availity starting July 27, 2026. Ongoing: 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. Contact Highmark Provider Services for access support: DE/PA/WV 888-601-7089, NY 888-601-8785, or visit providers.highmark.com/insights.