The Medical Policy Department

Mission Statement
The mission of the Medical Policy Department is to provide current and accurate medical policy guidelines for Highmark's medical-surgical products including Medicare Advantage products.

What we do
Highmark is a nationally recognized leader in developing and implementing up-to-date, medically sound policy guidelines. There are many policy guidelines addressing medical technology, therapeutic procedures, and medical equipment and supplies. These policies are developed and maintained in accordance with national standards such as NCQA, URAC, and the national Blue Cross Blue Shield Association. They are used to administer all Highmark medical-surgical products.

In addition to commercial products, we also maintain medical policy guidelines for our Medicare Advantage Products. The Centers for Medicare and Medicaid Services (CMS) requires that Medicare Advantage insurers use CMS national policy and the regional Medicare Part B Carrier's local policy for Medicare Advantage products. Therefore, the medical policies identified as Medicare Advantage generally represent the medical policy applied to the Medicare Program by Highmark Medicare Services, the local Medicare Part B carrier.

Last updated on 4/20/2018


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