April 2026

Guiding Conversations on Stress During Stress Awareness Month

During Stress Awareness Month, Highmark Wholecare encourages providers to proactively engage with patients regarding stress management and the effects it has on overall well-being. Read more about impact, strategies, and available resources.

Quality Improvement

Upcoming Medical Record Review Standards

Highmark Wholecare is required to perform medical record audits as part of our contract with the Pennsylvania Department of Human Services (DHS) to provide medical coverage for the Medical Assistance/Medicare population. Learn more about these periodic reviews and ensure you are keeping accurate and sufficient record documentation for your patients. 

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Billing Policy Update  

Medicare and Mental Health Incident to Provision

Physicians and certain non-physician practitioners can bill for "incident to" services and supplies provided by auxiliary personnel if specific requirements are met. Read more about requirements regarding these services and any applicable information for your practice.

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Coding Corner

Structured Screening for Developmental Delays and Autism Spectrum Disorders

The American Academy of Pediatrics remind providers to conduct structured screenings for developmental delays and Autism Spectrum Disorders (ASDs). The use of these screenings target specific developmental milestones in language and cognitive abilities, fine and gross motor skills, social interactions, as well as signs and symptoms of ASDs.

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Important information

Prior Authorization and Medical Policy Updates

Prescriber Notice: Diagnosis Code Requirement for Certain Medications

Highmark Wholecare Practitioner Excellence Incentive Program

Post-Acute Care Management: Authorization Process Has Changed

Annual HEDIS Medical Record Review

Member Rights and Responsibilities

Help your Patients through the Medicaid Renewal Process

Accessibility Standards

Model of Care Training

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.