CommercialReimbursementMedium impact
2026 True Performance Quality Incentive Threshold Changes
Highmark·PA, NY, DE, WV·Provider Bulletin
Effective date
Jan 1, 2026
We identified it
Jul 28, 2026
Summary
Highmark is adjusting the True Performance Lump Sum quality gate thresholds for 2026 to reflect customer demands for enhanced value and improved care outcomes. Specific threshold values are not detailed in this bulletin; providers must access the Value Insight Center (VIC) via Availity Essentials for complete details on how quality metrics and incentive calculations will change.
Action Required
By April 30, 2026: Billing and clinical leadership must access the Value Insight Center (VIC) in Highmark's Payer Spaces via Availity Essentials to retrieve complete threshold details and Program News under the Program Resources tile. Providers and billing staff should review the specific quality gate adjustments, update internal tracking protocols for True Performance incentive calculations, and communicate any workflow changes to clinical staff. Failure to understand new thresholds may result in inaccurate quality reporting and loss of performance-based incentive payments.