Commercial Payers

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.

Both policies will take effect on June 1, 2019.

​United Healthcare new consultation services policy will be implemented in phases.

Effective Feb. 1, 2019, Highmark will implement a 90 MME/day limit for opioid-naïve patients and members currently receiving less than 90 MME.

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

Find out why UHC is eliminating these numbers and what it means for physicians.

PAMED called for a public hearing to explore the possible implications of CVS-Aetna merger.

In-network access to UPMC hospitals ends June 30, 2019 for certain Highmark Medicare Advantage plans.

PAMED joined a coalition of 47 medical societies who asked for the data that led to the adoption of the IBC's modifier 25 payment policy, so that they could better understand why the policy was implemented.

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.

​Highmark has identified a scam in which fraudulent prescriptions are being faxed to physicians. Physicians and practices should be on the lookout for any prescriptions they did not initiate.