Short Takes: RSV Vaccines, Physical Medicine Changes, and More

RSV Vaccines Added to the Preventive Schedule for Infants and Adults

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.

New Process for Physical Medicine Management Program

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.

Annual Update to Highmark’s Professional Fee Schedule

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.

New Credentialing Enhancements and Search Capabilities for PDM Tool

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:

  • Request Credentialing – New providers can request initial credentialing.
  • Review Submitted Changes – Users can review the information they submitted.
  • Review Credentialing Status – Allows providers to see where they are in the credentialing process.
To learn about the tool’s new search capabilities, click here.

Medical Policy Update Newsletter

The September newsletter is available here.