August 2026

Harm Reduction: A Compassionate Path to Preventing Overdoses

National Overdose Awareness Day reminds us to continue the effort to prevent overdose related deaths. Read more for impactful approaches such as harm reduction, life-saving resources like naloxone, and ways to reduce stigma with your patients.

Process Update

PCP Member Rosters Available in the Provider Portal

Highmark Wholecare PCPs can access their member rosters within our provider portal. The rosters display real-time member data and can be downloaded into excel. Effective this November, rosters will no longer be available through US mailing services.

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Coding and Claims

Screening and Billing for Maternal Depression

Highmark Wholecare reminds providers about the importance of screening for postpartum depression, as it can increase opportunities for identification and intervention for both mother and baby. Additionally, proper billing codes should be used for each visit. Read more for valuable resources and more information.

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Annual Training

Model of Care Training

Highmark Wholecare providers are required to complete and attest to Model of Care (MOC) training on an annual basis. The training focuses on the SNP Provider Network section and outlines what is expected from providers to maintain an effective MOC in the new year.

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Important information

Prior Authorization and Medical Policy Updates

Perinatal Substance Use Disorder Management: Clinical Best Practices Virtual Training

Your Corrective Action Plans Support Compliance

Highmark Wholecare Practitioner Excellence (HWPE) Program: Opt-In Deadline & Webinar Reminder

Prescriber Notice: Diagnosis Code Requirement for Certain Medications

Medicare Parts A and B Cost-Sharing

The Provider News email is sent at the end of each month to share simple and consolidated updates about Highmark Wholecare member programs, provider policies, claims, reimbursement, and more.

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For Your Reference

• Notice of Practice/Practitioner Changes

• Cultural Competency

• Encounter Submissions

• Important Phone Numbers

The information in this newsletter is for Highmark Wholecare providers. For updates specific to Commercial and Medicare Advantage in Western or Northeastern PA, or Central or Southeastern PA, click here.

This information is issued on behalf of Gateway Health Plan, Inc. d/b/a Highmark Wholecare, an independent licensee of the Blue Cross Blue Shield Association. Highmark Wholecare provides Medicaid coverage for Blue Shield in 14 counties in central PA and Blue Cross Blue Shield in 14 counties in western PA. Highmark Wholecare provides Medicare Dual-Eligible Special Needs Plans (HMO D-SNP) for Blue Shield in 17 counties in northeastern PA, 13 counties in central PA, 5 counties in southeastern PA, and for Blue Cross Blue Shield in 27 counties in western PA. Highmark Wholecare offers HMO plans with a Medicare Contract. Enrollment in these plans depends on contract renewal.

Highmark Wholecare, 120 Fifth Ave., Pittsburgh, PA 15222

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