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HighmarkCommercial · Reimbursement · Provider Bulletin · PA, NY, WV, DE · Family Medicine, General Practice, Internal Medicine +1 moreHigh impact

Evolving Primary Care Reimbursement in 2027: Introducing ValueBlue and ValueBlue Connect

Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Aug 28, 2026

Summary

Highmark is replacing its current PCP fee-for-service and True Performance programs with two new value-based models effective January 1, 2027: ValueBlue (partial capitation with monthly payments for attributed members plus fee-for-service for preventive/wellness services) and ValueBlue Connect (incentive program rewarding quality outcomes and care coordination). This fundamentally changes how primary care providers are reimbursed, shifting from visit-based billing to population health management with stable monthly payments.

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What to do

by Dec 31, 2026 · 8 steps
01Billing team must transition all primary care provider reimbursement workflows from fee-for-service and True Performance models to ValueBlue and ValueBlue Connect.
02Update billing system configuration to process monthly capitation payments for attributed members in ValueBlue.
03Reprogram fee-for-service reimbursement rules to apply only to preventive and wellness services under ValueBlue.
04Configure ValueBlue Connect performance measure tracking and incentive calculations based on selected organizational metrics.
05Train billing staff on new payment reconciliation and monthly capitation billing processes.
06Update provider contracts and encounter documentation to align with capitation model.
07Contact Highmark at providers.highmark.com/valueblue to confirm eligibility, obtain program details, and receive implementation support.
08Providers must select performance measures for ValueBlue Connect prior to January 1, 2027.
If missed: Failure to transition may result in billing delays and payment processing errors when old programs terminate.

Original notice

Evolving Primary Care Reimbursement in 2027: Introducing ValueBlue and ValueBlue Connect
providers.highmark.com · Always check the source before changing claims.
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