Highmark’s Medical Review Committee resolves disputes between health service providers and Highmark. These disputes may involve utilization and quality of care issues, as well as alleged violations of participating provider agreements and appeals regarding network terminations. The Committee also considers and reviews appeals for providers who have been denied privileges to provide imaging services.
Four 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 four times a year at the Highmark campuses, both in Camp Hill and Pittsburgh, Pennsylvania. Members receive an honorarium from Highmark for attending the meetings and are also reimbursed for 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 October 1, 2020 to Earl.Bock@Highmark.com or the following address:
Earl Bock
Secretary, Medical Review Committee
Financial Investigations and Provider Review
Highmark Inc.
CH1AHM-033H
PO Box 890089
Camp Hill, PA 17089
