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HighmarkMedicare Advantage · Reimbursement · Provider Bulletin · WVHigh impact

ValueBlue Base Rates Set for 2027

Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Oct 22, 2026

Summary

Highmark is launching the ValueBlue partial capitation program for West Virginia providers effective January 1, 2027. Professional providers will receive monthly capitation payments based on 2027 base rates adjusted for patient health (MAF) and provider performance (PAF), with potential payment adjustments ranging from -20% to +40% based on quality and emergency department utilization metrics.

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What to do

by Dec 31, 2026 · 2 steps
01Providers must review the 2027 ValueBlue base capitation rates and performance adjustment factor (PAF) information published by Highmark.
02Billing team and providers should (1) access the 2027 PAF Report in the Static Reports Application within Provider Facing Analytics (PFA); (2) review the ValueBlue User Guide on the Provider Resource Center (PRC) ValueBlue and ValueBlue Connect page (accessible via Availity Essentials login); (3) understand the 2027 base rates by line of business (Commercial 18+ at $7.68 PMPM, Commercial under 18 at $19.28 PMPM, Medicare Advantage at $25.54 PMPM); (4) review the Member Adjustment Factor (MAF) on the monthly attributed member roster in Value Insight Center (VIC) starting January 2027; and (5) review the ValueBlue Connect incentive program for additional earning opportunities.
If missed: Failure to prepare may result in payment processing delays and missed incentive opportunities under the new capitation structure.

Original notice

ValueBlue Base Rates Set for 2027
providers.highmark.com · Always check the source before changing claims.
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