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Preventive Schedule Updates: Helping Highmark Members to Live Healthier in 2018 and Beyond

Highmark maintains a Preventive Schedule* for members that is intended to help them get the most out of their preventive care benefits — everything from regular physicals to specific screenings for members who are at risk for certain chronic or serious health conditions.

By publishing this information on the Provider Resource Center, we make it easy for you and your patient care staff to keep up with these recommendations as we work to keep our members healthy.

We revise and update our Preventive Schedule and Preventive Health Guidelines periodically to ensure that they reflect the latest evidence-based, nationally recommended clinical guidelines for care. Other changes simply clarify certain guidelines so they’re clear and understandable for our members.

Please note the following important updates:

Cardiovascular

The United States Preventive Services Task Force (USPSTF) mandates low to moderate dose select generic statin drugs for prevention of cardiovascular disease (CVD) for certain at-risk adults.

The Highmark Preventive Schedule now recommends such statins for adults ages 40 to 75 years with one or more CVD risk factors (such as dyslipidemia, diabetes, hypertension, or smoking) and who have a calculated 10-year risk of 10% or greater for a cardiovascular event.

Adult Diabetes Prevention Program (DPP)

For members who qualify for enrollment in certain select Centers for Disease Control and Prevention-recognized (CDC) lifestyle change DPPs for weight loss, the program now enhances prevention services to include onsite and virtual options for members meeting eligible enrollment criteria.

The eligibility criteria apply to adults 18 years and older and are:

  • Without a diagnosis of diabetes (does not include a history of gestational diabetes) and
  • Overweight or obese (determined by BMI) and
  • Fasting blood glucose of 100-125 mg/dl or HGBA1c of 5.7 to 6.4 percent or impaired glucose tolerance test results of 140-199 mg/dl

More information about this program is available in Issue 6, 2017, of Provider News.

For the Current Guidelines

To access the guidelines, visit the Resource Center via NaviNet® or our main website under Helpful Links. On the Resource Center, choose Education/Manuals and Clinical Practice and Preventive Health Guidelines.

We encourage you to consult our Preventive Health Guidelines when planning care for your patients with Highmark coverage, and we thank you for your commitment in addressing their health needs.

*Please note that most, but not all, of our customer groups follow the Highmark Preventive Schedule, meaning not all members may have coverage for services on the schedule. Therefore, when providing services for our members, please remember to check the member’s benefits via NaviNet or by using the appropriate HIPAA electronic transactions to determine if services are covered and if any associated member cost sharing applies. (If you do not have access to NaviNet, please call Provider Service to obtain benefits and eligibility information.)

 

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