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

ValueBlue Partial Capitation Reimbursement Begins Jan. 1, 2027

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

Summary

Highmark ValueBlue introduces a partial capitation reimbursement model for primary care providers (PCPs) effective January 1, 2027. PCPs must enroll by December 1, 2026, to participate; those who do not enroll will face a 20% reduction in capitated codes on the community fee schedule effective April 1, 2027.

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What to do

by Dec 1, 2026 · 5 steps
01Providers and billing teams must determine ValueBlue enrollment status.
02PCPs electing to participate should sign the ValueBlue amendment and enroll in ValueBlue Connect by the December 1, 2026 deadline to receive monthly partial capitation payments beginning January 1, 2027, and to earn additional incentives.
03Billing teams should review the 2027 ValueBlue base capitation rates and performance adjustment factor (PAF) for applicable regions (WPA/NEPA, CPA/SEPA, WV) via the Provider Resource Center.
04For PCPs not enrolling in ValueBlue, billing teams should be aware that capitated codes within Highmark's community fee schedule will be reduced by 20% effective April 1, 2027, and should plan for this change in fee schedule management.
05Attend the upcoming webinar for additional program details.

Original notice

ValueBlue Partial Capitation Reimbursement Begins Jan. 1, 2027
providers.highmark.com · Always check the source before changing claims.
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Related changes

See all Highmark changes →
ValueBlue Base Rates Set for 2027HighEffective Jan 1, 2027 · Provider BulletinValueBlue Base Rates Set for 2027HighEffective Jan 1, 2027 · Provider BulletinBrowse every Highmark change in the policy list

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