April 2025

Mental Health Awareness Month: A Time to Focus on Integrated Care

May is Mental Health Awareness month. There is a growing need to integrate both mental and physical health care to improve overall patient well-being. Read more about screening, intervention, resources, and Highmark Wholecare coverage at the link below.

Covered services

Diabetes Support with Good Measures

Members with Type 1 or Type 2 Diabetes can receive support from the Diabetes Support Program through Good Measures. This Program offers high-touch, high-tech guidance through various educational segments and an app to assist with making healthy food choices and tracking health goals.

Read more 

Care management

Screening and Treatment-Adherence for Hepatitis C

Hepatitis C virus (HCV) remains a significant public health challenge, largely because many infected patients are asymptomatic. For our Highmark Wholecare members, who may be facing additional risk factors, comprehensive screening and treatment are imperative to overall health. Read on to learn more about recommended screenings and direct-acting antiviral (DAA) therapy.

Read more 

Process updates

Attention EVV Providers: Netsmart Decommissioning after April 30, 2025

Access to Netsmart Mobile Caregiver+ will be unavailable to Highmark Wholecare Electronic Visit Verification (EVV) providers after April 30, 2025. We transitioned to HHAeXchange as our payer-sponsored EVV solution on November 1, 2024. Corrected claims and requests for review related to services provided before this transition must be submitted through the appropriate channels after the end of this month.

Read more 

Care management

Structured Screening for Developmental Delays and Autism Spectrum Disorders (ASDs)

Highmark Wholecare encourages structured screenings to identify developmental delays by targeting specific developmental milestones in language and cognitive abilities, fine and gross motor skills, and social interactions, as well as signs and symptoms of ASDs. The American Academy of Pediatrics (AAP) and other recognized medical organizations have established intervals to conduct developmental surveillance.

Read more 

Important information

• Provider Portal and Prior Authorization Update

• MA 112 Form Requirement for Newborns

• PCPs and OBGYNs: An Update on Doulas Enrolled in the Medical Assistance Program

• Clinical Practice and Preventive Health Guidelines

• Ensuring Quality Care and Service through our QI/UM Program

• HWPE Incentive Program and Care Gap Management Application

• CAHPS Cues: Making Specialist Referrals Easier

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.

Subscribe now 

For Your Reference

• Policy Updates

• Accessibility Standards

• Reminder: Help Your Patients through the Medicaid Renewal Process

• Notice of Practice/Practitioner Changes

• Please Complete the Cultural Competency Data Form

• Encounters Submissions

• Medicare Parts A and B Cost-Sharing

• Important Phone Numbers

Good Measures is a separate company that administers the Diabetes Support Program for Highmark Wholecare.

This information is issued on behalf of Highmark Wholecare, coverage by Gateway Health Plan, which is an independent licensee of the Blue Cross Blue Shield Association. Highmark Wholecare serves a Medicaid plan to Blue Shield members in 13 counties in central Pennsylvania, as well as, to Blue Cross Blue Shield members in 14 counties in western Pennsylvania. Highmark Wholecare serves Medicare Dual Special Needs plans (D-SNP) to Blue Shield members in 17 counties in northeastern Pennsylvania, 13 counties in central Pennsylvania, 5 counties in southeastern Pennsylvania, and to Blue Cross Blue Shield members in 27 counties in western Pennsylvania.

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

Privacy Policy | Non‑Discrimination Policy