Commercial Payers

UnitedHealthcare’s pharmacy benefit manager OptumRX requires e-prescriptions for controlled substances filled by home delivery pharmacy service.

Find out how to verify your data with Highmark. Plus, check out ways to verify directory data for Medicare, Medicaid, and CAQH.

Highmark is holding a series of webinars that provide an overview of the new quality metrics and a demonstration of the enhanced scorecard for 2019

Highmark has launched its Specialist Efficiency Report pilot program, aimed at analyzing and comparing care costs among providers. These webinars provide an overview of the reports and a tutorial of the practice scorecard.

On Jan. 10, 2019, a stakeholder group which included PAMED met with Highmark to discuss the Advanced Imaging and Cardiology Services Program.

Get guidance on how to provide topical fluoride varnish applications, including training requirements and associated billing/reimbursement.

​Effective Aug. 1, 2017, Independence Blue Cross changed its policy on payment when Modifier 25 is used. PAMED strongly opposes this policy change.