Highmark - General Information – Test Zendesk Vida

Highmark Health operates health plans nationwide that serve more than 4.4 million members and hundreds of thousands of additional individuals through BCBS. Highmark is the 4th largest overall BCBS affiliated organization in the country.

There are 3 pay orgs under the Highmark umbrella. Each of these is a Highmark “brand:”

AllMyHealth*
Highmark Blue Cross Blue Shield
Highmark Blue Shield

*Members from AllMyHealth may not know what “Highmark” is so the plan should be referred to as their “AllMyHealth” plan.

Zendesk Org Tags

Highmark - AllMyHealth
Highmark - Blue Cross Blue Shield
Highmark - Blue Shield

Landing Pages:

Programs & Devices Offered

For full details on programs offered, please review one of three Vidapedia cards:

For full details on devices offered, please review Device Eligibility Google Doc

Condition Control Program Launch and Support Details

Who is eligible?

The only program offered for Highmark members will be Condition Control. Highmark members with CHF and/or COPD are included on the eligibility file. If the member has exclusion criteria they should be referred back to their Health Plan, via the phone number on the back of their insurance card.

Members with High Deductible Health Plans (HDHPs)

Members on a HDHP are expected to be billed for services if their deductibles have not been met and if they meet with a prescriber ONLY. Members who have not met their deductible can still enroll in Vida and use the service for free, but meeting with a prescriber will trigger a direct bill to the member. Since meeting with a prescriber is part of the CC program, this expectation of member cost liability should be set before program enrollment. If member has already met their deductible for the year, they will not be billed for any prescriber consults.

Before enrolling the member…

Ask the member if they’re currently on an HDHP plan. (TBD: this may be available to view in B2B, waiting to hear from Calvin). If yes, share the following information before proceeding:

You can enroll in Vida and participate in this program for free. However, if you meet with a prescriber to talk about prescribing or deprescribing medications, and you haven’t met your annual deductible, then you would be responsible for paying for that virtual prescriber appointment. Keep in mind the prescriber is different from your health coach/RD so you can always ask them more about this. Typically out of pocket costs for prescriber visits range from $10-110.

Remember: member liability only exists if the member is on HDHP and has an encounter with a prescriber (NP), not if they just use the Vida service.

If an existing member is on an HDHP and is unable or unwilling to pay…

Our policy is to write off the member’s statement bills and cancel their account.

For billing inquiries or issues from HDHP members, follow the escalation process outlined in this KB Article

If Member States They Do Not Have COPD/CHF

Use Macro: Account Support::Highmark Member Does Not Have COPD/CHF

Hi {{ticket.requester.first_name}},

Thanks for letting us know that you don’t have a COPD/CHF diagnosis.

The Vida program offered through your organization helps improve heart and lung health, so your eligibility is likely due to related conditions. Vida can help if you have trouble breathing, wheeze or cough, get swelling in your feet, don't sleep well, or use an inhaler or heart meds.

With this in mind, would you be interested in signing up for Vida?

Feel free to let us know if you have any questions. We’re here to help in any way we can.

Population Details

70,000 members
- Medicare Advantage - 23,346
- Fully Insured - 4,552
- ACA (Exchange) - 1,412
- Administrative Services Only (ASO) - 15,406 - requires client sale

States: 23 states, most members in PA, WV, NY, DE, OH

Additional Info

What segment is this org in?
- Health plan
Are there any Fees at risk (FAR) org?
- Yes
  - Telephone - Speed to answer: Measure of % of total calls answered <45 seconds
    Telephone - abandoned calls: fewer than 5% of calls >30 seconds are abandoned
    Inbound support email inquiry response: Measurement of % of total customer support emails answered within two (2) business days
When did we launch with this org?
- 1/1/24
How is the service being paid for?
- Vida is available at no cost to Highmark members, except for HDHP members. See section above regarding member liability for HDHP members that have not yet met their deductible.
How do members enroll?
- Vida App, VSC outreach campaign
Where should non-eligible members be directed?
- Back to their health plan. They can contact the number on the back of their insurance card.
Who is eligible?
- Highmark members with CHF and/or COPD included on the eligibility file. If the member has exclusion criteria they should be referred back to their Health Plan.
Is the org on the eligibility file?
- Yes
How often will terminations take place?
- Monthly [Typically this is the answer]
Do we offer Phone and/or Email support?
- Phone + Email
Is VSC outreach involved?
- Yes

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Highmark - General Information