Behavioral Health Telemedicine and Virtual Visits

Spring HealthMental 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.

Spring Provider Referral Form (Referrals accepted starting January, 1, 2024)

Additional information about Mental Well-Being can be found here.

 

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.

 

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. Click on the links below to view more information on how each program works and how to make a referral.

Behavioral Health Need Support Program

Child, Adolescent and Young Adult Behavioral Health

Charlie Health – Joint Commission-accredited Mental Health Intensive Outpatient (IOP) program serving teens and young adults for anxiety, depression, OCD, and PTSD/panic attacks

  • Available to Commercial members in Pennsylvania and Delaware (ages 11-33)

Panic Attacks and Post-Traumatic Stress Disorder (PTSD)

Freespira – a digital therapeutic approach to significantly reduce or eliminate symptoms of panic attacks and PTSD in 28 days; this approach trains users to normalize respiratory irregularities by addressing CO2 hypersensitivity, an important underlying physiological factor in panic attacks, Panic Disorder and PTSD  

  • Available to Commerical and ACA members in Delaware, Pennsylvania, and West Virginia who are 18 years or older and have symptoms of Panic Disorder or Post Traumatic Stress Disorder (PTSD). 

Teens and Young Adult Mental Health Therapy

Meru Health – provides immediate access to mental health for Depression, Anxiety and Burnout using an integrated, mind/body approach to guide patients step-by-step towards better and long-lasting health 

  • Available to Commercial and ACA members in Delaware, Pennsylvania, and West Virginia who are 18 years or older

Obsessive Compulsive Disorder (OCD)

NOCD delivers virtual face-to-face therapy for patients with OCD with specialized therapists who are trained in Exposure and Response Prevention Therapy (ERP) 

  • Available to Commercial and ACA members in Delaware, New York, Pennsylvania, and West Virginia who are 5 years or older

Alcohol Use

Ria Healthuses medications, online counseling, support and technologies to help members cut back or quit drinking alcohol from the comfort of their homes via telehealth

  • Available to Commercial, ACA, and Medicare members in Delaware, Pennsylvania, and West Virginia who are 18 years 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:

  1. Are eligible for separate reimbursement
  2. Are part of the member's benefit
  3. Fully meet the definition of the code and can be safely and effectively delivered through a virtual option
  4. 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 3/1/2024 4:02:49 PM

 

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