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Virtual Health

Highmark has offered virtual health services for many years, but the COVID-19 pandemic provided an opportunity for many of its members to try virtual health for the first time. The benefits of providing both members and providers with the efficiency and safety of virtual health are here to stay.

Virtual health services mean the use of synchronous or asynchronous telecommunications technology by a health care practitioner to provide health care services, including, but not limited to:

Virtual Visit Doctor

  • Assessment
  • Diagnosis
  • Consultation
  • Treatment and monitoring of a patient
  • Transfer of medical data
  • Patient and services

 

Virtual care can complement a physician’s practice by:

  • Improving patient outcomes
  • Increasing access to health care while providing scheduling flexibility and increased productivity
  • Reducing patient/office staff/clinician exposure to pathogens
  • Cutting down on hospital readmissions
  • Boosting patient engagement and satisfaction

Telemedicine and Virtual Visits

Highmark differentiates between telemedicine and virtual visits. Telemedicine is services provided by Highmark-approved telemedicine vendors. Virtual visits are services provided by Highmark in-network providers within the scope of their license, deemed appropriate using their medical judgment, and delivered within the definition of the code billed. In-network providers do not need to utilize telemedicine vendor services to provide virtual services to Highmark members. These vendors are a separate option and benefit to certain members.

  • Well360 Virtual Health (Effective January 1, 2024 for New York members)
    Well360 Virtual Health is a digital experience that allows members to connect with a health care expert either online, through the Highmark member portal, or via the Well360 app (powered by Amwell).

Provider Manual

Chapter 2, Unit 5 of the of the Highmark Provider Manual outlines telemedicine services including PCP, behavioral health and specialist visits. The Provider Manual also outlines benefits and approved vendors.

Reimbursement Policy

See Reimbursement Policy RP-046 Telemedicine and Telehealth Services for more detailed information and coding guidance. The policy outlines Highmark's reimbursement for telemedicine, telehealth, virtual-care, or eVisit services. 

Last updated on 11/15/2023 9:10:27 AM

 

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Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration.