Network Access & Adequacy
AI Summary
Highmark has updated their Network Access & Adequacy requirements with specific appointment timeframes for mental health and substance use services in New York (10 business days for initial appointments, 7 calendar days for follow-up after hospital/ER discharge) and clarified network adequacy standards for West Virginia requiring out-of-network services at in-network rates when network standards aren't met.
Action Required
Immediately: For New York Highmark members, ensure mental health and substance use appointments are scheduled within required timeframes (10 business days initial, 7 days post-discharge). Contact Highmark at 1-888-697-8695 if network providers unavailable within timeframes. For West Virginia members, utilize out-of-network providers at in-network benefit levels when network adequacy standards cannot be met.
Plan Types
All Plans
States
NY, WV
Specialties
psychiatry, family-medicine, internal-medicine