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Highmark adjusts controversial program

By , - Last modified: December 28, 2012 at 9:39 AM

Highmark Inc. has announced that, due to feedback from providers, it is adjusting its Physical Medicine Management Program.

Prior to Dec. 17, PMMP limited payment to four modalities per visit, even if the provider determined that more were medically necessary. Highmark said it changed its policy to reduce administrative burden, with claims for all visits from Dec. 17 on to be processed and paid “in a timely manner” regardless of the number of modalities and then subject to retrospective review.

“The provider may be asked to provide documentation to support the medical necessity of the additional modalities/units and may be responsible for refunding a portion of the original payment,” according to a statement on the subject from the Pittsburgh-based insurer.

Highmark said all other aspects of the PMMP remain in place and unchanged. PMMP affects physical therapy, occupational therapy and manipulation (chiropractic and osteopathic) services, and a recent posting by the Pennsylvania Chiropractic Association characterized its campaign against PMMP as a successful intervention.


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