COVID-19 Vaccine Reimbursement

When our members visit your office or facility this year, they may have questions about the programs and services available to them through Highmark. These patients may be new to Highmark or they may be existing members who were previously unaware of current resources.

That is why we want to give you notice of Highmark Member programs and services available to commercial and Medicare Advantage members in 2023. To help you and your staff answer questions, we recently published an overview of these programs and services on the Highmark Provider Resource Center (PRC).

The 2023 Reference Guide of Highmark Member Programs includes the following sections:

  • Clinical Care
  • Disease Management
  • Specialty Case Management
  • Diabetes
  • Wellness and Prevention
  • Comprehensive Lifestyle
  • SDOH (Social Determinants of Health)
  • Home Support
  • Behavioral Health
  • Specialized Mental and Behavioral Health
  • Substance Use Disorder

To access the guide, go to the PRC, select EDUCATION/MANUALS, and then click Reference Guide Of Highmark Member Programs.

Full Range of Programs and Services

The Reference Guide is designed to create awareness about the full range of programs and services available to Highmark members. It contains useful information and resources to give you and your team a comprehensive understanding of the programs offered to Highmark members in all service areas and for all lines of business.

Please be aware that programs may be discontinued or additional information may become available; if that occurs, the guide will be updated accordingly. Also, coverage for each program may vary based on member benefits and members should consult their individual plans for coverage details.

Highmark encourages providers to identify members who can benefit from Highmark programs and services. Please use the Case Management Referral and Inquiry link available via NaviNet® to submit a referral electronically for programs unless other enrollment information is stated in the description.

For more about Case Management Referrals, see the article in this month’s Provider News.