Virtual Health

Highmark has offered virtual health services for many years, but the COVID-19 pandemic provided an opportunity for many of its members to try virtual health for the first time. The benefits of providing both members and providers with the efficiency and safety of virtual health are here to stay.

Virtual health services mean the use of synchronous or asynchronous telecommunications technology by a health care practitioner to provide health care services, including, but not limited to:

Virtual Visit Doctor

  • Assessment
  • Diagnosis
  • Consultation
  • Treatment and monitoring of a patient
  • Transfer of medical data
  • Patient and services

 

Virtual care can complement a physician’s practice by:

  • Improving patient outcomes
  • Increasing access to health care while providing scheduling flexibility and increased productivity
  • Reducing patient/office staff/clinician exposure to pathogens
  • Cutting down on hospital readmissions
  • Boosting patient engagement and satisfaction

Telemedicine and Virtual Visits

Highmark differentiates between telemedicine and virtual visits. Telemedicine is services provided by Highmark-approved telemedicine vendors. Virtual visits are services provided by Highmark in-network providers within the scope of their license, deemed appropriate using their medical judgment, and delivered within the definition of the code billed. In-network providers do not need to utilize telemedicine vendor services to provide virtual services to Highmark members. These vendors are a separate option and benefit to certain members.

 

Well360 Virtual Health Options Description

Well360 Virtual Dermatology Clinic

With Well360 Virtual Dermatology Clinic, patients can share skin, hair and nail concerns with one of more than 160 certified dermatologists. Patients can get treatment and prescriptions for chronic conditions and new diagnoses, or schedule follow-ups with a dermatologist (up to 30 days from initial appointment)

Well360 Virtual Urgent Care

Well360 Virtual Urgent Care provides 24/7 on-demand urgent care. Patients can get care for chronic and acute conditions, avoiding costly emergency department, urgent care and inpatient utilization.

Well360 Virtual Women's Health Clinic

Well360 Virtual Women’s Health clinic offers acute care for women’s health issues with a licensed obstetrician/gynecologist. Patients receive medical care as well as counseling during and after pregnancy with lactation concerns.

 


Provider Manual

Chapter 2, Unit 5 of the of the Highmark Provider Manual outlines telemedicine services including PCP, behavioral health and specialist visits. The Provider Manual also outlines benefits and approved vendors.


Reimbursement Policy

See Reimbursement Policy RP-046 Telemedicine and Telehealth Services for more detailed information and coding guidance. The policy outlines Highmark's reimbursement for telemedicine, telehealth, virtual-care, or eVisit services. 

Last updated on 12/18/2023 11:25:58 AM

 

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