Whether our members need a regular physical or an important health screening, Highmark wants to help them get the most out of their preventive care benefits.
That’s why we maintain a Preventive Schedule* of services to help members stay as healthy as possible.
By publishing the schedule on the Provider Resource Center (PRC), 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. Some of these changes simply clarify certain guidelines, so they are clear and understandable.
Please note the following important updates, which will take effect Jan. 1, 2019:
The age-range limit for adolescent hearing screenings will be increased from age 18 to age 21.
Coverage will be removed for vitamin D supplements to prevent falls for members age 65 and older. The United States Preventive Services Task Force recommends against such supplementation for adults 65 and older who aren’t known to have osteoporosis or vitamin D deficiency.
To access the guidelines, visit the PRC via NaviNet® or under Helpful Links on our main website. On the PRC, choose Education/Manuals and then 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 to 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 members’ 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.)
NOTE: These guidelines are for information only. The physician or other health professional will advise the member of the applicable guidelines and any related advice, testing, diagnosis, or treatment. Health plan coverage is subject to the terms of the member’s health plan benefit agreement.