July 2026

PCP Member Rosters Now Available in the Provider Portal

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

Coding and Claims

Early and Periodic Screening Diagnosis, and Treatment Visits for Children in Foster Care

The American Academy of Pediatrics recommends that children and adolescents in foster care receive two provider visits each year. For additional information on billing guidelines, refer to the Highmark Wholecare Provider Manual.

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Patient Resources

Introducing the Beginnings Box for New Mothers

The Beginnings Box is an initiative created to help members who gave birth in 2026 through providing supplies and resources, to ease the initial burdens of parenthood. For eligibility and access to the Beginnings Box, providers are encouraged to direct members to Highmark Wholecare Member Services.

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Coding and Claims

Colonoscopy Coding

Correct colonoscopy coding addresses why the procedure was performed and the intent of the order. This distinction can affect diagnosis sequencing, procedure code selection, modifier use, and claim routing. Read more for additional information to help you with this process.

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Promoting Quality

Black, Indigenous, and People of Color Mental Health Awareness Month

Black, Indigenous, and People of Color (BIPOC) mental health awareness month is a reminder for providers to address disparities in access, diagnosis, treatment, and outcomes for BIPOC communities. Providers can work with their patients through culturally competent and equity-focused care as well as offering Highmark Wholecare resources for our members.

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Important information

Prior Authorization and Medical Policy Updates

Medicare GLP-1 Bridge: New CMS Program for Certain Weight-Loss Drugs

Screening and Billing for Anemia

Physician Portfolio Reports are Distributed

Electronic Visit Verification Training

Highmark Wholecare Practitioner Excellence Incentive Program Opt-In Reminder

Updated Language Data for our Medicaid Population

Medicaid: Community Health Worker Enrollment and Billing Instructions

Prescriber Notice: Diagnosis Code Requirement for Certain Medications

How to Help your Patients through the Medicaid Renewal Process

Accessibility Standards

Medicare Parts A and B Cost-Sharing

Model of Care Training

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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