Care Management Programs

AIS Home Visit Program 
In collaboration with Aspire Health, the AIS Home Visit Program is focused on caring for our Medicare Advantage and ACA members who have a serious illness.

Laboratory Management Program
The resources contained on this page will assist providers in their understanding of the Laboratory Management Program

Physical Medicine Management Program
The materials contained in this location will assist the provider in their understanding of the Physical Medicine Management Program.

Post-Acute Care Management For Medicare Advantage Members
Highmark has initiated a three-year partnership with naviHealth, a national post-acute care management company, to bring a personalized approach to support its Medicare Advantage members across Pennsylvania. According to patient needs, naviHealth will utilize decision-support technology and its post-acute analytics capabilities to coordinate long-term acute care, inpatient rehabilitation and skilled nursing facility utilization and will oversee proper care transitions to and from these facilities. Through a highly collaborative process, this partnership enables us to increase member satisfaction, lower readmission rates and improve clinical outcomes

Radiation Therapy Authorization Program
In an effort to help ensure that the radiation oncology therapy services provided to our members are consistent with nationally recognized clinical guidelines, Highmark has contracted with eviCore healthcare to provide medical necessity review and authorization where applicable for select radiation oncology therapy services.

Radiology Management Program
eviCore provides medical necessity review and authorization, where applicable, for select outpatient Cardiology and Radiation Therapy services for Highmark members. You can review eviCore's evidence-based clinical guidelines by accessing eviCore's Highmark implementation site at evicore.com/healthplan/Highmark.

Last updated on 1/31/2019

 

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