Mental Well-Being powered by Spring Health
Mental Well-Being powered by Spring Health offers an expanded network of behavioral health providers in addition to a digital experience. Highmark’s partnership with Spring Health expands timely access to mental and behavioral health care for Highmark members. Mental Well-Being features personalized care throughout the continuum (low to high acuity needs) from self-guided tools and wellness coaching to virtual care with a therapist or psychiatrist and 24/7 crisis support. Click the link below to refer a patient to Mental Well-Being and Spring Health will reach out to the patient.
Additional information about Mental Well-Being can be found HERE or by reviewing the Reference Guide of Highmark Member Programs.
Note: Mental Well-Being is available to Commercial, Medicare Advantage, and ACA members in Delaware, New York, Pennsylvania, and West Virginia (age 6 or older).
Well360 Virtual Behavioral Health
Well360 Virtual Behavioral Health provides virtual psychiatry and therapy services for members seeking care for conditions like depression, anxiety, stress management, relationship challenges, and child behavior difficulties. Services also include talk therapy, counseling, medication management, and more.
Additional information about Well360 Virtual Behavioral Health can be found HERE or by reviewing the Reference Guide of Highmark Member Programs.
Note: Well360 Virtual Behavioral Health is available to Commercial, Medicare Advantage, and ACA members in Delaware, Pennsylvania, and West Virginia. Therapy services are provided to children (ages 10-17) and adults. Medication management is provided to adults (age 18 or older).
Virtual Visits
Highmark reimburses mental health providers for outpatient care delivery. Please see Highmark's Provider Manual Chapter 2, Unit 5 for more information regarding the services that may be provided through this modality and other guidelines.
DOES HIGHMARK CONTRACT WITH ANY CONDITION-SPECIFIC VIRTUAL PROVIDERS?
Yes, in an effort to increase access to Behavioral Health treatment, Highmark has contracted with providers that offer comprehensive virtual treatment for specific behavioral health conditions.
Below is a listing of support programs. For more information on how each program works and how to make a referral, review the Reference Guide of Highmark Member Programs.
| Behavioral Health Need |
Support Program |
|
Depression/anxiety, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD)/panic disorder
|
Charlie Health – Joint Commission-accredited mental health intensive outpatient (IOP) facility serving teens and young adults.
- Available to Commercial and Medicaid members in Delaware and Commercial members in Pennsylvania (ages 11-33).
|
|
PTSD/panic disorder
|
Freespira – Medication-free, medical device used twice daily for 28 days to treat mild to moderate panic disorder and mild symptoms of PTSD. Freespira uses a sensor that provides feedback on respiratory rate and exhaled CO2, which is communicated to an app (on a tablet) that guides the user through a 17-minute intervention to normalize breathing. It is not intended as a standalone intervention but as an adjunct to treatment with a mental health professional.
- Available to Commercial (not including FEP) and ACA members in Delaware, Pennsylvania, and West Virginia (age 18 or older).
|
|
Depression/anxiety
|
Meru Health – Twelve-week virtual mental health program for adults. Includes therapy with licensed therapists, digital content, peer support groups, coaching, biofeedback (heart-rate variability), and psychiatrist-to-PCP consultation. (Note: Members do not have direct access to psychiatry.) Focus of treatment is anxiety and depression.
- Available to Commercial (not including FEP) and ACA members in Delaware, Pennsylvania, and West Virginia (age 18 or older).
|
|
OCD
|
NOCD – Telehealth provider that specializes in OCD along with tic and hoarding disorders, excoriation, trichotillomania, and postpartum OCD. NOCD provides Highmark members with live one-on-one video therapy with exposure and response prevention (ERP)-trained therapists, access to a peer community, and a personalized self-management tool.
- Available to Commercial and ACA members in Delaware, New York, Pennsylvania, and West Virginia (age 5 or older).
|
|
Alcohol use disorder
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Ria Health – Virtual program for adults for treatment of alcohol use disorder with medication-assisted treatment (e.g., naltrexone) provided by addiction medicine physicians and advanced practice registered nurses (APRNs), coaching, digital content, and support groups. (Note: Ria treatment model does not use licensed mental health therapists.)
- Available to Commercial and ACA members in Delaware and Commercial, Medicare Advantage, and ACA members in Pennsylvania and West Virginia (age 18 or older).
|
*Note: In-network providers do not need to utilize these vendor services to provide telehealth services to Highmark members. These vendors are a separate option and benefit to certain members.
WHAT SERVICES CAN BE OFFERED VIA VIRTUAL VISITS?
Please see Highmark’s Provider Manual, Chapter 2, Unit 5 for more information regarding the services that may be provided through this modality and other guidelines.
*Medicare Advantage NOTE: Highmark Medicare Advantage plans continue to follow The Centers for Medicare and Medicaid Services (CMS) guidelines for telemedicine visit coverage and reimbursement. Only the codes identified by CMS as appropriate for telemedicine services will be reimbursed by Highmark for Medicare Advantage members.
WHAT TELEHEALTH CODES ARE REIMBURSABLE BY HIGHMARK?
Highmark will continue to reimburse providers for virtual visits at parity with face-to-face services if the services:
- Are eligible for separate reimbursement
- Are part of the member's benefit
- Fully meet the definition of the code and can be safely and effectively delivered through a virtual option
- Are not specifically disallowed by a Highmark medical or reimbursement policy
The use of place of service 02 (Telehealth Provided Other Than in Patient's Home) or 10 (Telehealth Provided in Patient's Home) for 1500 claims when billing for virtual health services is still required along with the appropriate use of modifier 95 on the applicable claim lines.
*Medicare Advantage NOTE: Highmark Medicare Advantage plans continue to follow CMS guidelines for telemedicine visit coverage and reimbursement. Only the codes identified by CMS as appropriate for telemedicine services will be reimbursed by Highmark for Medicare Advantage members.
For more information on billing and reimbursement for commercial and Medicare Advantage products, please see Highmark Reimbursement Policy Bulletin RP-046: Telemedicine and Telehealth Services.
Last updated on 3/28/2024 4:25:03 PM