As you may have heard, Highmark’s Freedom Blue PPO product was recently notified by the Centers for Medicare and Medicaid Services (CMS) about errors in Highmark’s online physician network directories. Below are talking points for your reference if a beneficiary asks for additional information.

Articles regarding the matter were published in the Pittsburgh Post-Gazette and Kaiser Health News.

Of the over 300 MA plans in the nation, our Freedom Blue PPO network was among the 54 plan networks recently audited by CMS for provider directory accuracy.

Provider directory accuracy is a national issue being addressed by insurers and trade groups across the country. It’s an issue, because providers in a group practice are frequently listed as being accessible at all practice locations for payment purposes, when indeed, an individual practitioner within the group typically only accepts patients at one practice and only occasionally see members at other sites.

The plan named in the audit, Freedom Blue PPO, is rated as a CMS 4.5 STAR plan. This is the first time we have been audited by CMS on this issue, and there are no sanctions or financial penalties from CMS in this audit. Our level of notice from CMS is a warning and does not require follow up with the agency, however, we take this notice very seriously and have immediately taken action to address the issue.

The Freedom Blue PPO provider network has more than 35,000 physicians. Since alerted of CMS’ preliminary audit results in the spring of 2016, we have made thousands of outbound calls to providers at 3 or more locations, confirming where they actually practice and accept patients. By month’s end, we will have completed updates to our directory to reflect this new data.

Since May 2016, we began conducting monthly audits of our provider listings to continue to improve and maintain our directory accuracy. In addition, we are pursuing a vendor to aid our internal processes for even more efficient data collection on providers.

Fortunately, we have not received any formal complaints from our members about our provider directory through 1-800-Medicare, nor seen a trend in grievances. Our member service representatives are trained to assist members in all of our MA products to find in-network providers and assist in scheduling appointments.

Highmark is the largest MA plan in Pennsylvania with a variety of MA networks across Western, Central and Northeastern PA – including Freedom Blue PPO, Security Blue HMO and Community Blue Medicare HMO. Highmark has 99% of its total MA membership enrolled in 4.5 Star rated plans. This is the third year in a row that we have been rated 4.5 Stars for Freedom Blue PPO in PA.

Nationally, Highmark has the third highest volume of MA membership (HMO and PPO together) enrolled in plans that are rated 4.5 Stars or higher (based upon October 2016 data). Only 12 PPOs attained a 4.5 Star rating nationally, Highmark has the largest membership of this group, thus is the largest, highest rated PPO in the country.

We would greatly appreciate your assistance distributing this important information to all your agents.