Several times annually, Highmark notifies providers of important policies and guidelines. The following notification is for your information and reference.
The Quality Program has been designed to improve the quality, safety, and equity of the clinical care and services provided to our members. To do this, we continually review the aspects that affect member care and satisfaction and look for ways to improve them.
We work closely with the physician community in our efforts to address both the clinical care and service our members receive, as well as plan management to address the services provided by the organization (i.e., authorizations, claims handling, appeals, etc.). We also use member satisfaction surveys and other tools to get feedback on how we’re doing. These results are used to guide our future clinical, service, network, member safety, health equity, and quality improvement activities.
For more information about the Quality Program, including information about program goals and a report on progress toward meeting those goals, please visit our online Provider Resource Center via NaviNet® or through our main website under Helpful Links. On the Resource Center, select Education/Manuals.
Professional providers should select Highmark Blue Shield Office Manual, and see “Chapter 4: Health Care Management, Unit 5: Highmark Quality Program” to view the Quality Program information.
Facility providers should select the Highmark Facility Manual and see “Chapter 4: Care Management and Quality Improvement Manual, Unit 8: Quality Improvement.”