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Upcoming Changes for Highmark Condition Management Programs
Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Sep 24, 2026
Summary
Highmark is discontinuing four condition management programs effective January 1, 2027: Onduo/Verily Diabetes Management, Vida CHF/COPD Management, Well360 Behavioral Health Services, and related programs. Type 2 diabetes patients may transition to Noom Weight Management; behavioral health patients may access Spring Health. Billing teams must remove these programs as referral options from Availity Essentials by the effective date.
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What to do
by Dec 31, 2026 · 6 steps
01Billing and clinical teams must.
02Remove discontinued condition management program referral options from Availity Essentials system, including Onduo/Verily Diabetes Management, Vida CHF/COPD Management, and Well360 Behavioral Health.
03Update internal referral protocols and encounter forms to reflect only active programs.
04Notify providers that these programs will no longer appear as referral options.
05Educate staff on alternative resources: Noom Weight Management for eligible type 2 diabetes patients and Spring Health for behavioral health members.
06Review member rosters to identify patients currently enrolled in discontinued programs for outreach before January 1, 2027.
If missed: Failure to update referral systems may result in claims being rejected or delayed if referrals are submitted for discontinued programs after the effective date.
Original notice
Upcoming Changes for Highmark Condition Management Programs
providers.highmark.com · Always check the source before changing claims.