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:
- 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).
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.
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