Several times annually, Highmark notifies providers of important policies and guidelines. The following notification is for your information and reference.
Highmark recently issued new reimbursement policies for independent diagnostic testing facilities and for telemedicine and telehealth services. In addition, the policy on drug wastage and convenience kits has been revised.
Reimbursement Policy Bulletin RP-048: Independent Diagnostic Testing Facility (IDTF)
An IDTF can be a mobile entity or a fixed location, and must operate its business following all Federal and State Licensure requirements. Highmark’s new Reimbursement Policy Bulletin RP-048, effective July 15, 2019, includes Highmark’s guidelines for billing and reimbursement.
Reimbursement Policy Bulletin RP-046: Telemedicine and Telehealth Services
Effective July 15, 2019, Highmark Reimbursement Policy Bulletin RP-046 provides guidance on the reimbursement of telemedicine, telehealth, virtual care, and e-Visit services for commercial and Medicare Advantage products.
Reimbursement Policy Bulletin RP-003: Drug Wastage and Convenience Kits
A revised version of Highmark Reimbursement Policy Bulletin RP-003 has been issued with added reimbursement rate information for claim lines reported with modifier JW (drug/biological amount discarded/not administered to any patient). This change implements a cost-based approach for drug wastage reimbursement for commercial professional claims effective August 5, 2019.
To access Highmark reimbursement policy bulletins, select CLAIMS, PAYMENT & REIMBURSEMENT from the Provider Resource Center main menu, and then click on Reimbursement Policy.
