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Highmark -Unconfirmed Diagnosis Codes Payments to Primary Care Physicians

Primary Care physicians have the opportunity to earn up to $165 per member for complete and accurate UDC Forms

As announced last week, Highmark has developed a new, higher level of additional compensation for the Unconfirmed Diagnosis Code (UDC) Program.
This allows PCPs to earn additional compensation of up to $165 per member if 75% or more of their UDC Form(s) have been returned, and are deemed complete and accurate, by October 31, 2016.

A Summary of the Additional Compensation Structure for the UDC Program
Level 1: $125 per member for complete and accurate member-level UDC Form(s)
Level 2: Total of $150 per member when 60% or more member-level UDC Form(s) are accurately completed between Apr. 1 – Oct. 31, 2016* ($25 additional multiplier per member)
Level 3: Total of $165 per member when 75% or more member-level UDC Form(s) are accurately completed between Apr. 1 – Oct. 31, 2016* ($40 additional multiplier per member)
* After Providers reach the higher level of additional compensation, they will be paid at that level for all accurate completions received during the full 2016 UDC Program.

The UDC Program is a clinically based Provider/Highmark collaboration to review diagnosis conditions requiring annual evaluation and/or treatment. It includes previously reported and/or suspected diagnosis conditions that may not have been reported to Highmark in the current year.

Questions concerning the UDC program should be directed to:

Diane Berneburg
Director Professional Provider Relations
Highmark Health Services
412-544-4806
412-544-8871 (fax)

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Allegheny County Medical Society
713 Ridge Avenue
Pittsburgh, PA  15212
412-321-5030  FAX 412-321-5323