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Highmark is seeking new members to serve on its Medical Review Committee for the next two-year term of 2019-2020.
Highmark’s Medical Review Committee resolves disputes between Highmark and Pennsylvania-contracted health service practitioners. These disputes may involve billing disputes and quality-of-care issues, as well as alleged violations of participating provider agreements, credentialing denials, and appeals regarding network terminations. The Committee also considers and reviews appeals for providers who have been denied privileges to provide imaging services.
Nine doctors of medicine, one doctor of osteopathy, one doctor of chiropractic, one physical therapist, and two consumer representatives now serve on the Committee. The Medical Review Committee Selection Committee appoints the members to a two-year term. Members may be reappointed.
The Medical Review Committee generally meets three to four times a year, or as needed based on cases and schedules. The meetings are held at the Highmark campuses, both in Camp Hill and Pittsburgh, Pa. Members receive an honorarium from Highmark for attending the meetings and are also reimbursed for reasonable travel expenses.
Considerable preparation time for the meetings may be required. Members are expected to attend all meetings and be prepared to participate in each case discussion.
All potential candidates must be a Pennsylvania-licensed health care provider who is a party to one or more professional provider contracts with Highmark.
If you are interested in being considered for membership by the Medical Review Committee Selection Committee, please send a copy of your current resume or curriculum vitae by June 29, 2018, either through email to earl.bock@highmark.com, or through U.S. mail to:
Earl Bock
Secretary, Medical Review Committee
Highmark Blue Shield
1A-L3
P.O. Box 890089
Camp Hill, PA 17089
