On December 4, 2023, Highmark will transition utilization management (UM) of outpatient physical medicine services — physical therapy, occupational therapy, and manipulation services — from Tivity^® to Helion Arc.

This change impacts providers in Delaware, Pennsylvania, and West Virginia only.

To assist providers, Highmark will offer training webinars on November 28, 2023, and December 7, 2023, with one-hour sessions scheduled for 10 a.m. and 1 p.m. (EST) on both days. The same material will be presented in all four sessions.

Additional Training Support

While registration for each session is limited, a recorded version of the training webinar will be made available on the Provider Resource Center (PRC), following the November 28 sessions.

Transition Timeline

Starting on December 4, 2023, providers should contact Highmark regarding the following processes:

Process	How to Contact Highmark
Retrospective Reviews	Medical Review, PO Box 890392, Camp Hill, PA 17089-0392
Appeals	Appeal instructions are provided on both the denial notification AND in the “Standard Provider Appeal Process” section of the Highmark Provider Manual, Chapter 5, Unit 5.
Peer-to-Peer Request	To initiate the request, providers should call the dedicated, peer-to-peer phone number: 866-634-6468. Hours of operation are from 8:30 a.m. to 4:30 p.m. (EST), Monday through Friday.
Date Change, Extensions, etc.	All other requests should be directed to Highmark Utilization Management at the dedicated number: 800-452-8507.

The Physical Medicine Management Program page, including all documents, will be removed from the Provider Resource Center (PRC) effective December 4, 2023.

Additional Resources

To learn more about the change to Helion Arc, see last month’s article in Provider News and/or read the FAQs on the PRC.

For immediate questions, please contact the Ancillary Provider Contract Administration Team via email: AncillaryProviderContractAdministration@Highmark.com.