As we approach 2026, we want to express our gratitude for your unwavering commitment to creating remarkable health experiences for our members. Your dedication, especially during complex times, is the cornerstone of our shared mission.
"Our close collaboration with providers is fundamental to delivering value to our members,” said Michael Edbauer, DO, MBA, Senior Vice President, Markets. "Like you, we are deeply rooted in the communities we serve across Delaware, New York, Pennsylvania, West Virginia – and soon Kansas City. Our devoted local teams and meaningful relationships with providers throughout our footprint ensure our strategies are grounded in the unique needs of each market."
At Highmark, we understand the complexities of healthcare from a unique vantage point – not just as a payer, but as a clinically integrated system that also provides direct care. This dual role informs our strategies as we collectively navigate the evolving and often demanding health care landscape. It allows us to understand the hurdles you face firsthand and to partner with you in finding solutions.
We are continually working to enhance our processes, provide valuable resources, and foster an environment that supports you and your care for our members.
"We deeply value the direct input from our providers on our tools and programs,” said Michael Consuelos, MD, MBA FAAP, Senior Vice President, Provider Transformation. “It’s instrumental in shaping our strategies and ensuring our continuous evolution in how we effectively support you and our members.”
- wpa/ nepa
- cpa/ sepa
- wv
- wny
- neny
The integration of CertifyOS into our credentialing platform earlier this year is a direct result of provider feedback.
“We recognized the frustration around turnaround times and transparency in the credentialing process, and a key goal in choosing this solution was to quickly address both those issues," Consuelos said.
These changes in 2025 were also the direct result of feedback from our network:
- Expanded Gold Carding Program – More than 25,000 clinicians now receive streamlined authorization determinations based on their historical adherence to clinical criteria.
- New Communications Hub on the Provider Resource Center – A central source of the most current information on our website for easy reference.
- Monthly Onboarding Webinars – Taking the mystery out of our processes and sharing the basics for navigating Highmark’s systems.
- Sign up for the Jan. 22 webinar here.
- Provider Chat in Pennsylvania - Answers to questions on claim status, authorization status, eligibility and benefits, and self-service tools without having to wait on the phone.
- Expanding to other Highmark markets in early 2026.
- Expanding to other Highmark markets in early 2026.
Looking ahead, initiatives like Highmark Provider Perspectives, our new online provider community, are designed to actively solicit your insights and allow your voice to directly inform our content, technology, and future initiatives.
“The invaluable contributions you make, especially considering the challenges we face, are foundational to achieving remarkable health experiences for our members,” said Dr. Consuelos. “We eagerly anticipate deepening our collaboration as we continually innovate to provide accessible and affordable healthcare across our communities.”
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