A newsletter for the Highmark Blue Shield providers in central Pennsylvania, the Lehigh Valley, northeastern Pennsylvania and southeastern Pennsylvania
Issue 9, September 2023
The Centers for Disease Control and Prevention (CDC) has approved respiratory syncytial virus (RSV) vaccines for infants and adults. These vaccines are being retroactively added to the Highmark Preventive Schedules. There is no cost share for members who have plans with the standard preventive schedule. Click here
to read the Special Bulletin.
In December 2023, Highmark will transition utilization management of outpatient physical medicine services — physical therapy, occupational therapy, and manipulation services — from Tivity® to Helion Arc. Helion Arc is integrated within the Predictal™ Utilization Management tool and enables offices to submit, update, and query medical authorization requests. The application supports the management of members’ care from end-to-end — including submission, case review and decision-making, and prescribed treatment programs. To read the recent Special Bulletin, click here.
Effective October 1, 2023, Highmark will make its annual update to our standard professional fee and pricing methodology, which applies to the following Highmark service areas — Delaware, Pennsylvania, and West Virginia — for commercial lines of business. To read the Special Bulletin, click here.
Highmark continues to roll out enhancements to its new Provider Data Maintenance (PDM) tool. Professional providers can now perform the following Credentialing functions via the PDM tool:
.
The September newsletter is available here.
