SSBCI Provider Attestation Alert
Use the SSBCI Provider Attestation form to support your Wholecare Dual Eligible patients in qualifying for extra benefits to support their health, like money for healthy food and utility payments.
Pharmacy Update:
Rite Aid has announced the closure of over 150 pharmacy locations that will no longer be available to our members. We encourage you to assist impacted patients find alternative pharmacies by visiting our website and selecting “Find a Pharmacy” or directing members to call the Member Services number on the back of their insurance card. We appreciate your partnership in helping patients navigate this change!
CAQH Transition
Highmark Wholecare has changed how we verify our provider directory information. To meet CMS and DHS requirements, our providers must verify their directory information every 90 days. We are now utilizing the CAQH Directory Management Solution to complete this verification, which will help simplify the attestation process. Read more about how you can complete your attestation in CAQH.
Member Billing Policies Reminder
Providers cannot bill a Medicaid member for covered services (excluding copays) & must accept the Plan’s payments as payment in full. A member cannot be denied service if unable to pay copay. Our Medicare Assured members shall not be held liable for Parts A & B cost sharing when the appropriate Medicaid agency is liable. Federal law prohibits balance billing a dual eligible for deductible/coinsurance/copay.
Annual Provider Training
The 2025 Annual Provider Education and Orientation Training is now available on-demand and can be viewed at your convenience! The training provides current information to help you care for our Highmark Wholecare members on topics like claims, prior authorization, self-service tools, Model of Care, and more.
E-Subscribe Provider Website
The Highmark Wholecare Provider Newsletter has been replaced with the Provider News monthly email. The Provider News email will become our primary communications channel, allowing us to consolidate and simplify updates for you each month. Subscribe here to stay up-to-date with Highmark Wholecare member programs, provider policies, claims, reimbursement, and more!
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