Medicare Advantage Network Updates: What Providers Need to Know

As part of our ongoing commitment to providing our members with access to high-quality, affordable, comprehensive care, Highmark continually evaluates our provider networks to ensure they meet evolving member and market needs.

Aligned with this commitment, Highmark is updating select Medicare Advantage networks, effective Jan. 1, 2026. Impacted providers and members will receive letters outlining these changes and what they may mean for them.

Note: These changes do not impact Commercial or Affordable Care Act (ACA)

As a Highmark participating provider, here are some steps you can take to confirm you know the networks in which you participate — and ensure your patients do not incur any unexpected costs.

1)    Verify Your Network Status

You can view your network status using our self-service tools.

Professional Providers:

• Use the Provider Data Maintenance (PDM) tool on Availity Essentials^® to confirm your participation status in all Highmark networks.
  • Log into Availity.
  • Navigate to Highmark's Payer Spaces.
  • Select the appropriate health plan payer.
  • Find PDM under "Applications."
  • Select an organization.
    • A PDM user guide is available under "Resources" in Highmark's Payer Spaces.

Facility and Ancillary Providers:

Call Provider Service at 800-950-0051 and a representative can provide details on your network status.

2)    Check Member Eligibility

Verify member eligibility and benefits before appointments through Availity’s Patient Registration feature. This helps ensure members receive in-network care and avoid unexpected costs.

You will need the Member ID, date of birth, and specific service information.

3)     Verify Network Status for Referrals

Confirm that the provider you are referring a member to is in-network for the member's specific plan.

You or your patients may use our online Provider Directory to verify in-network provider participation at any time.

• Visit Highmark.com/Find-Care.
• Scroll down on the page and find the region that’s closest to your address, then select Find Care.
• Select Find a Doctor under the Find Care section.
• On the pop-up window, click “Choose a location and plan.” Enter your ZIP Code and then click on the Don’t know your alpha prefix? Browse a list of plans link to select a plan from the list.
• Choose how you want to search.
  • You can enter a doctor name or specialty, a facility name or type, or just search all.

A link to the Provider Directory is also available here on the Provider Resource Center under Provider Network in the main website menu.