Highmark Delaware New Policy Designates Services Not Eligible for Separate Reimbursement

September 2018 ~

Highmark Delaware has identified certain procedure codes that will not be eligible for separate reimbursement and has issued a new policy.

The insurer’s new reimbursement policy, Services Not Separately Reimbursed, will include the list of applicable procedure codes. The reimbursement policy will become effective on December 1, 2018 and will apply to Commercial products.

Highmark will apply the guidelines within the new reimbursement policy to claims processed on or after December 1.

NOTE: Highmark considers the services not eligible for separate reimbursement to be an inherent part of another service. Reimbursement for the services will be included in the global allowance for other services not specified. If the services listed in the reimbursement policy are submitted for separate reimbursement, they will be denied. The provider may not bill the member for the denied charge.

For more information or to review the Services Not Separately Reimbursed Policy (RP-041), available 12/01/2018, refer to Highmark’s Provider Resource Center.



Source(s): Highmark Delaware Special eBulletin August 29, 2018;