Medicare AdvantageAdministrativeMedium impact
Are You Eligible for High-Performance Networks?
Highmark·PA, NY, DE, WV·Provider Bulletin
Effective date
Jan 1, 2027
We identified it
Aug 28, 2026
Summary
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.
Action Required
Before next month's network participation communications: Providers must access Practice Performance Insights via the Provider Facing Analytics tool in Availity Essentials at providers.highmark.com/insights to review their practice performance scorecard against peer benchmarks. Identify performance gaps in quality, care appropriateness, documentation quality, and cost efficiency measures. Implement corrective action plans for any underperforming areas to maintain High-Performance Network eligibility. Billing team should coordinate with clinical leadership to ensure documentation quality standards are met, as poor documentation can trigger network participation changes effective 2027. Failure to meet performance thresholds may result in loss of high-performance network participation and associated reimbursement models starting January 2027.