Dear Membership – please note Highmark is transitioning from Tivity / Wholehealth to Helion for their Utilization Management. They report the transition will take place in December 2023. They have yet to announce the exact date. Please see the 3 PDF’s to help better understand the transition.
- Highmark Introducing New Process for Physical Medicine Management Program
- NaviNet® Provider Portal and Helion Arc Authorization Submission
- Authorizations For Home Health, Hospice & Outpatient Therapy Routed to New UM Tool
Helion Arc will be going live for PA, WV, DE on 12/4. The official end-date for Tivity is 12/19. During the time between 12/4-12/19, Tivity will be completing any outstanding work. The go-live for Helion for NY will be 1/1/24.
If you are referencing any authorization submitted to Tivity prior to the go-live with Helion on 12/4- those authorizations will be processed as usual. Any new authorizations, or appeals/Peer to Peers will be processed by our UM team.
If we need any information from Tivity, they have agreed to provide any clinical data we need to make determinations
For more information please visit the Provider Resource Center:
In the October newsletter there was an updated comms with training dates: https://hbs.highmarkprc.com/pnews/pn-10-2023/new_process_physical_medicine_management.html .
That same comms was posted on the PRC and portals. https://content.highmarkprc.com/Files/NewsletterNotices/SpecialBulletins/sb-physical-medicine-mgmt-process-de-pa-wv-090723.pdf