PITTSBURGH, Jan. 17 /PRNewswire/ -- Highmark Blue Cross Blue Shield’s Medicare Advantage HMO, SecurityBlue, and FreedomBlue, its PPO, recently earned the designation of “Centers for Medicare & Medicaid Services (CMS) Certified Compliance Program.” This prestigious certification means that Highmark’s Corporate Compliance and Integrity programs have met the stringent criteria set forth by CMS in order to be exempt from biennial monitoring reviews for a period of up to three years. Instead, Highmark has been approved to submit its own internal audit reports, which will result in cost- and time-savings for both Highmark and CMS.
“Receiving the CMS certification reinforces Highmark’s firm organizational commitment to compliance and integrity,” said Cynthia Dellecker, senior vice president of Highmark senior products.
The pilot project, developed by CMS, is part of an overall initiative to control rising administrative costs without compromising the integrity of Medicare managed care programs and to ensure beneficiaries continue to receive the best care. Highmark was one of only a few plans nationally to participate.
In addition to a thorough review of all of Highmark’s compliance and integrity programs, staff from CMS’s Central and Philadelphia regional offices conducted an intensive onsite evaluation. This assessment included interviews with 20 randomly selected employees and compliance staff to confirm compliance training efforts and to assess the comfort level of staff to raise questions or report potential noncompliance without fear of retaliation.
“CMS looked at every tenet of our program, including grievance, claims processing and appeals, our audit process and governance structure,” said Dellecker. “We demonstrated to CMS through our audit plan that we not only comply with all of their rules and regulations, but we also communicate them effectively to our members, providers and employees.”
The Compliance Program Certification Project is voluntary for Medicare Advantage plans and was developed to reward those plans that have exemplary compliance programs. Highmark was successful with CMS’ first review and was granted permanent status rather than provisional status since no significant changes had to be made to existing programs and processes.
With more than 183,000 members, SecurityBlue is the nation’s fourth largest Medicare HMO. An additional 4,000 members are currently enrolled in FreedomBlue. Highmark Blue Cross Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. For more information, visit http://www.highmark.com/ .
Highmark Blue Cross Blue Shield
CONTACT: Denise Grabner, +1-412-544-7488, or denise.grabner@highmark.com, or Hollie Plevyak, +1-412-544-8248, or hollie.plevyak@highmark.com , both ofHighmark Blue Cross Blue Shield
Web site: http://www.highmark.com/