Virtual Visits – How They Relate to Behavioral Healthcare Providers

According to a recent report by the Institute of Medicine , the demand for behavioral health care services is increasing, but the access to qualified specialists is limited. Due to this, patients often have long wait times and may even give up on receiving help. Additionally, even when care is available, patients may be afraid to seek help due to social stigma.

To help combat these concerns and to better help your patients, Highmark offers Virtual Behavioral Health visits to our members. This allows patients to get the care they need, even when they’re too afraid to seek help due to social stigma.

IMPORTANT: Virtual visits are not meant to replace in-person visits and support. You must determine what channel or channels of care is best for your patient and that the patient’s plan provides the appropriate benefits for the anticipated service.

Benefits of Virtual Visits

Virtual visits provide many benefits, including:

• More access to mental health care, especially for patients with multiple chronic health conditions, severe illness and disability, or underserved populations in rural and remote areas.
• Some patients may be less fearful when they are not meeting you face-to-face in your clinic or office.
• Counseling and intervention services can be delivered via teleconferencing sessions instead of through an on-site appointment which may take longer to arrange.
• Virtual visits are cost-effective and allow you to deliver care anywhere* anytime without the administrative costs for you and the travel costs for your patients.
• You can conduct consultations to triage cases and help reduce emergency room visits and hospitalizations by providing less costly forms of care for your patients.

*All services are subject to state law requirements and restrictions.

Eligibility Requirements

You are eligible to provide your patient with this care option if:

• You have the necessary telecommunications technology to support a virtual outpatient mental health visit
• The services performed fall under the scope of your license
• The sessions are conducted following Highmark’s recommended service and security guidelines
• The services are covered benefits under the member’s health benefit plan.

Service and Security Guidelines

You must follow the following guidelines when conducting virtual behavioral health visits:

• Virtual visits must be conducted through real-time interactive audio and video telecommunications hardware and software that are Health Insurance Portability and Accountability Act (HIPAA) and Health Information Technology for Economic and Clinical Health Act (HITECH) compliant.
• IMPORTANT: Highmark is not responsible for the security of virtual visits and does not validate the safeguards of any of the equipment and software used on either side of the virtual transmittal.
• All services provided must be medically appropriate and necessary.
• Services performed must fall under the scope of your license.
• You must comply with local, state, and federal laws, and other regulatory agency requirements.
• Treatment and consultations, including the authorization and dispensing of prescription medication(s), must be held to the same professional standards as those in a traditional in-office face-to-face encounter.
• You must take the appropriate steps to establish a doctor-patient relationship and conduct all evaluations and history consistent with traditional standards.
• You must have all relevant medical information to deliver a competent medical diagnosis, treatment, and counseling plan.
• Documentation of the real-time interactive audio and video telecommunication relevant to the ongoing medical care of your patient should be maintained as part of your patient’s medical record.

More Information

For more information on how virtual visits may relate to you, please review Chapter 2.5 of the Provider Manual (located on the Provider Resource Center under Education/Manuals).

For reimbursement guidelines, locate Reimbursement Policy 046 Telemedicine and Telehealth Services (on the Provider Resource Center, under CLAIMS, PAYMENT & REIMBURSEMENT, on the Reimbursement Policy page).