Medicare Part B Claim Changes Effective Jan. 1, 2026

As part of our ongoing efforts to ensure accurate claims processing and adherence to government program guidelines, Highmark will be enforcing the Government Program language in our member and client contracts and agreements effective Jan. 1, 2026.

What This Means for You

Members who become eligible to have Medicare as their primary payer on or after Jan. 1, 2026, and do not elect to have Part B coverage, Highmark will pay for Medicare Part B services as if Medicare made a primary payment for those services. Payment for services that are not included in Highmark’s Part B payment will be subject to the patient’s responsibility. For more information on Medicare primacy rules, visit the Centers for Medicare and Medicaid Services website. 

Note: this enforcement will only impact fully insured and alternate-funded lines of business for Medicare-eligible members.

Claims subject to Part B enforcement will be indicated on provider vouchers on and after Jan. 1.

We appreciate your attention to these upcoming changes. Highmark values our partnership with you and is dedicated to supporting you in providing quality care for our members.