In response to the COVID-19 pandemic and pandemic-related laws, Highmark implemented many policies and flexibilities waiving or requiring certain actions in response to the pandemic’s effect on health care delivery.
Highmark’s policy changes and insurance plans/product updates listed below will take effect on July 6, 2023. These changes were originally communicated via a Special Bulletin and Plan Central message on April 7, 2023.
Liability immunity has been extended to providers based on the Public Readiness and Emergency Preparedness (PREP) Act to allow for greater delivery of and access to medical countermeasures. These protections will expire on October 1, 2024.
Note: Some state mandates regarding COVID-19 will still be in place once the federal PHE ends. Highmark will follow all federal and state regulations regarding COVID-19 policies.
With the expiration of the PHE, Highmark has started the process of updating COVID-19-impacted policies and procedures including:
Highmark will extend the following waivers to Highmark members with employer-sponsored or individual health insurance coverage until June 1, 2023*:
For Medicare Advantage (MA) members, Highmark will extend the following waivers with Highmark MA insurance coverage until June 1, 2023*:
West Virginia: Cost share waiver mandates related to lab testing, OTC tests, and vaccinations may continue to be in place after the federal PHE ends.
*While this coverage applies to most Highmark members, every plan is a little different. If members have any questions, they should login to their member portal and send a message using the Message Center to Member Service. Members can also call Member Service using the number on the back of their insurance card.
After June 1, 2023, the services above may have out-of-pocket costs based on member plan coverage.
Over the counter COVID-19 tests will no longer be covered, with members responsible for paying the full cost of these kits. Free tests from the federal government are available at www.covid.gov/tests until supplies run out.
Many telehealth flexibilities expanded during the PHE will remain in place. Virtual COVID-19-related care will be treated like any other telehealth service.
Reminder: For years prior to the PHE, Highmark had allowed the delivery of virtual visits by practitioners. Please see the Highmark Provider Manual , Chapter 2, Unit 5: Telemedicine Services , for more information regarding the services that may be provided through this modality and other guidelines.
The following Medical Policies will be updated:
To review the Medical Policies, click on MEDICAL POLICY SEARCH in the gray Quick Links bar at the top of the Provider Resource Center.CMS Disaster Memo: Paying All Out-Of-Network Claims as In-Network
Effective July 6, 2023, Telehealth and Virtual Health components of the following Reimbursement Policies (RP) will be removed:
RP–010: Incident To Services
The supervising physician must be physically present. Virtual supervision will no longer be allowed.
RP–027: Hemodialysis and Peritoneal Dialysis
Procedure codes 99401, 99402, 99403, 99404, 99411, and 99412, will no longer be eligible to be performed as telemedicine. Similarly, procedure codes, 99221, 99222 and 99223, will no longer be eligible to be performed as telemedicine.
RP–041: Services Not Separately Reimbursed
The following procedure codes 90887, 99024, 99374, 99377, 99378, 99379, 99380 and 99483 will no longer be eligible to be performed as telemedicine.
New York will no longer reimburse for code U0005.
RP–046: Telemedicine and Telehealth Services
The provision that — Eligible Providers performing and billing telehealth services must be eligible to independently perform and bill the equivalent face-to-face service — is being reinstated.
Note: Additional COVID-19-related language will be removed effective May 29, 2023.
RP–015 Professional and Technical Components for Applicable Services
Exceptions for procedure codes 99000 and 99001 as diagnostic services are being eliminated.
RP–016: Physician Laboratory and Pathology Services
Exceptions for procedure codes 99000 and 99001 as clinical pathology tests are being eliminated.
RP–054: Ambulance Services
Destination requirements for ground transports that were waived during the PHE are being reinstated.
You can review all current Reimbursement Policies on the Provider Resource Center. Click on CLAIMS, PAYMENT & REIMBURSEMENT in the left-hand menu and scroll down to Reimbursement Policy.
Additional information on Timely Requirements can be found in the Highmark Provider Manual: Chapter 6, Unit 1 – General Claim Submission Guidelines.
Highmark members were notified of changes related to coverage and cost share waivers through our website on March 22, 2023. These changes will affect members starting June 1, 2023. For additional information on these changes, visit highmarkanswers.com .