A newsletter for the Highmark Blue Shield providers in central Pennsylvania, the Lehigh Valley, northeastern Pennsylvania and southeastern Pennsylvania
Issue 10, October 2023
On December 4, 2023, Highmark will transition utilization management (UM) of outpatient physical medicine services — physical therapy, occupational therapy, and manipulation services — from Tivity® to Helion Arc.
Helion Arc is integrated with the Predictal™ Auth Automation tool and enables offices to submit, update, and query medical authorization requests. The application supports the management of members’ care from end-to-end — including submission, case review and decision-making, and prescribed treatment programs.
The move to Helion Arc is the result of Highmark’s long-term commitment to enhancing the overall provider experience. While this does represent a change in the way that providers request prior authorizations for physical medicine services, the goal is to minimize provider disruption and ensure that the transition to Helion Arc is as seamless as possible. Aside from some minor differences in the user interface design, the overall process will remain very similar.
To assist providers with this change to Helion Arc, Highmark will offer training webinars on November 28, 2023, and December 7, 2023, with one-hour sessions scheduled for 10 a.m. and 1 p.m. (EST) on both days. The material being presented is the same in all sessions, so you only need to attend whichever is most convenient with your schedule.
You must register via the links to receive the credentials to join the webinar. To register, click the webinar date that you would like to attend:
While registration for each session is limited, a recorded version of the training webinar will be made available on the Provider Resource Center, following the November 28 sessions.
Providers who previously qualified for the Tivity Provider Pathways Program for 2024 can expect a similar level of self-management under the new process. Qualifying providers may still receive up to 20 auto-approved visits for each member without medical necessity review.
For a list of Frequently Asked Questions, click here
.
For immediate questions, please contact the Ancillary Provider Contract Administration Team via email: AncillaryProviderContractAdministration@Highmark.com.
Note: This change impacts providers in Delaware, Pennsylvania, and West Virginia only.
