Notifications for Providers

Several times annually, Highmark notifies providers of important policies and guidelines. The following notification is for your information and reference.

Quality Program Information Available Online

The Quality Program has been designed to improve the quality, safety, and equity of the clinical care and services provided by providers to our members. To do this, we continually review the aspects that affect the quality of the member care experience and satisfaction and look for ways to improve them.

We work closely with the physician community in our efforts to address both the quality of the clinical care and service our members receive, as well as plan management to address the services provided by Highmark (i.e., authorizations, claims handling, appeals, etc.). We also use member satisfaction surveys and other tools to get feedback on how we’re doing. These results are used to guide our future quality improvement activities and programs supporting such focuses as the clinical care and service received by our members, the provider network, member safety and health equity.

For more information about the Quality Program, including information about program goals and a report on progress toward meeting those goals, please visit our online Provider Resource Center via NaviNet® or through our main website. Once on the Provider Resource Center, from the black navigation bar at the top, select Highmark Provider Manual. See “Chapter 5: Care & Quality Management, Unit 6: Quality Management.”