Quality Program Information

Highmark’s Quality Program has been designed to improve the quality, safety, and equity of the clinical care and services providers render to our members. To do this, we continually review aspects of the program that affect the quality of the member care experience, including member satisfaction, and look for ways to make improvements.

Highmark works 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 for the services provided by Highmark (i.e., authorizations, claims handling, appeals, etc.).

We also use member satisfaction surveys and other tools to elicit feedback on how we’re doing. These results are used to guide our future quality improvement activities and programs, supporting such areas as:

  • The Clinical Care and Service Received by Our Members
  • The Provider Network
  • Member Safety and Health Equity.

To learn more about the Quality Program, including information on program goals and a report on progress toward meeting those goals, please visit the Provider Resource Center.

Once on the Provider Resource Center, select Highmark Provider Manual from the gray navigation bar at the top. See “Chapter 5: Care & Quality Management, Unit 6: Quality Management.”