fee scheduleHighmark Commercial Standard Professional Fee Schedule & Pricing Methodology Update

Per Highmark’s most recent Fee Schedule and Pricing Methodology Update1, a new commercial standard professional fee schedule2 will be effective on October 1, 2021.

This update allows Highmark to:

  • Update our fee allowances based on industry research by leveraging different sources and data points, including changes the Centers of Medicare and Medicaid Services (CMS) made to the 2021 Medicare Physician Fee Schedule.
  • Continue to bring closer alignment with Highmark’s value-based reimbursement strategies through uniform standard fees.

to come...

You may review the updated standard professional fee schedule within NaviNet® beginning September 1, 20213. Follow this path: NaviNet > Workflows for This Plan > Resource Center > Fee Schedule Information. (This is the same page where you can access Highmark’s current fee schedule.)

If you have any questions, please contact your Provider Account Liaison or Highmark’s Provider Service Center at 888-391-7426.

1 Any changes to the commercial standard professional fee schedule and pricing methodology will comply with 18 Del. Code §§ 3342B and 3556A.

2The new fee schedule will be applicable in all of Highmark’s service areas (Pennsylvania, Delaware, and West Virginia) for the commercial lines of business. This change does not affect Highmark’s Medicare, Medicaid, or any value-based fee schedule adjustments.

3Choose the Fee Schedule Information navigation tab on the Provider Resource Center accessible from NaviNet (as you would access the current fee schedule).