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Provider Access Corrective Action Plan (CAP) Online Submission Form

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Step 1: Complete the Practice Site Detail fields below

(*Must be completed)

Note: Choose Medicaid and Medicare only if your practice site was audited for both Medicaid and Medicare and the corrective action plan (CAP) covers all failed standards.

Step 2: Please check the box below that identifies your practice site's Action Plan Status

Corrective Action Plan Status Choose one

Step 3: Please identify your sites Barrier(s) to meeting the Provider Access Standards

Barrier(s) Choose all that apply

Step 4: Please identify the Corrective Action(s) your site has taken to ensure the Access Standards are met

Corrective action(s) Choose all that apply

Step 5: By entering your name and title below you are attesting that your practice site has completed staff training and a practice Self-Assessment to ensure that you meet Highmark Wholecare's Access Standards

Attestation* (Should be completed by an Office Administrator or Corporate compliance)

Step 6: If you wish to UPLOAD documentation related to your Accessibility Corrective Action plan, click the "Upload Documentation" button below

  • No documentation uploaded
  • Attached File: {{file.name}} - [Remove]

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The following entities, which serve the noted regions, are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield. West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Health Insurance Company or Highmark Senior Solutions Company. Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield. Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield.

All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration and/or to one or more of its affiliated Blue companies.