News for Northeast PA Providers:
PCP Auto-Assignment Program for HMO ACA Members

Effective for 2019 Open Enrollment

One of Highmark’s primary concerns is supporting our members’ overall good health. The Patient Protection and Affordable Care Act of 2010 (ACA) has enabled more Americans to purchase quality, affordable health care coverage from insurers like Highmark.

Highmark understands that a key to our members’ overall care coordination is selection of a PCP.  We encourage members to make this selection at enrollment. While many members make this selection immediately, Highmark has identified some health maintenance organization (HMO) ACA members who didn’t initially select a PCP. 

That’s why Highmark is implementing a new program called PCP Auto-Assignment for HMO ACA members, effective with the 2019 open enrollment period. The new program will ensure members select a PCP at enrollment. Or, for members who do not select a PCP immediately, one will automatically be assigned.

PCP Auto-Assignment will work as follows:

• Existing members: Highmark systems will review the existing member history. If the member previously had a PCP, he/she will be confirmed as in-network for the member’s current network. If yes, this physician will be the member’s current PCP. If no PCP was selected previously, Highmark’s systems will locate a PCP in the closest geographic region where the PCP indicates acceptance of new patients. 
• New members: Highmark’s systems will locate a PCP in the closest geographic region where the PCP indicates acceptance of new patients.

Highmark appreciates the quality care you provide to our members, and we believe this integrated program will assist in better achieving more effective patient care.