Highmark 24/7 Coverage for Therapists: Now and in 2027

Last reviewed: October 7, 2026.

Highmark requires 24/7 coverage from its network therapists: a member who calls after hours must be able to reach you or a designee, with a response within 60 minutes. Through the end of 2026 it is checked during credentialing and recredentialing. From January 1, 2027, Highmark stops checking it at that step and instead spot-checks practices, but the requirement itself stays.

The “Action Required” notice therapists are getting

Highmark runs credentialing through a vendor, Certify. When the application does not say how coverage works, the clinician’s credentialing contact receives an “Action Required: Update Needed” email that asks how the primary practice meets the 24/7 requirement, often with a coverage form attached. The notices we have received cite Highmark’s Network Credentialing Policy and warn that credentialing may be discontinued if the update is not completed, and that vague answers can delay it.

The methods listed in those notices include:

• Direct access to the provider or a same or similar specialty designee by answering service, pager or phone.

• A provider-issued cell phone answered 24/7.

• An answering machine with a callback from the provider or designee.

• Office staff who triage after-hours calls and escalate to the on-call provider.

• After-hours texts or emails answered by the provider within 60 minutes.

For behavioral health providers the notices add two conditions: a crisis line alone is not acceptable unless the crisis service can reach the provider or designee directly, and individualized crisis plans with after-hours steps must be in place. Psychologists who only perform psychological or neuropsychological evaluations are exempt.

Answers that get sent back

In our experience the follow-up comes when the answer describes intent rather than a route. “The owner covers for the group” is not enough. Highmark wants the specific way a member reaches someone: which number they call, who answers or calls back, and that the callback happens within an hour. A voicemail that only tells callers to go to the ER or dial 911 or 988 does not show that a clinician can be reached.

A workable reply for a small group names the after-hours line members call, says that it rings through to the clinicians or takes a voicemail with a callback number, and confirms that a clinician returns those calls within 60 minutes. If the practice also accepts calls from crisis centers, say so; that supports the crisis-line condition.

What changes on January 1, 2027

Highmark’s September 21, 2026 announcement says 24/7 coverage will no longer be a validated component of credentialing and recredentialing. Instead, a random sample of 100 practices will be contacted each month to confirm their coverage. If coverage cannot be verified, follow-up can include education, clarification or a notice of termination, which practices can appeal.

So the practical change is timing. Today the question can stall an application. From 2027 it can arrive as an outreach call or letter to a practice that is already in network, and a missed response is a network risk rather than a credentialing delay. Keep the after-hours process documented and make sure whoever answers the practice’s mail knows to route that outreach.

Keep the answer true

Describe the arrangement that exists. Do not list a colleague who has not agreed to cover, or promise a callback time nobody can meet. Clinical decisions about crisis plans belong with the treating clinician, not the credentialing form.

Bomi answers these Certify notices for the clinicians it credentials with Highmark, after confirming the coverage details with the practice. Highmark has also changed telehealth coding this year; see Highmark commercial telehealth codes 98000–98015.

Frequently Asked Questions

Did Highmark drop the 24/7 coverage requirement for 2027?

No. It stops verifying coverage during credentialing and moves to monthly random checks of practices. The obligation stays.

Can my voicemail just tell clients to call 988 after hours?

Not on its own. Highmark lists crisis lines as acceptable for behavioral health only when the crisis service can reach the provider or a designee directly.

What happens if I ignore the Certify request?

The notices say Highmark may discontinue the credentialing process if the requested update is not completed.

Sources

• Highmark: changes to 24/7 coverage requirements for providers

• Highmark provider manual: what’s new