August-2025--Provider-Newsletter

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August 2025

 

 
August 2025

New at
Highmark Wholecare

Expanding Access to Behavioral Health: A Crucial Step for Overall Well-being

We can work together to improve access to behavioral health services for members. Addressing mental health and substance use disorders is essential for improving patient outcomes and reducing health care costs. Learn more about resources available to your Highmark Wholecare patients.

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Promoting quality

2025 HWPE Overview Webinar Series & Opt-In Deadline

Don’t miss the September 30th opt-in deadline for our 2025 Highmark Wholecare Practitioner Excellence (HWPE) Program. To learn more, consider attending our upcoming HWPE Program overview webinar on September 23rd.

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Coding corner

Flu Vaccinations for Medicare Beneficiaries

Flu vaccination is a critical preventive service covered under Medicare Part B, with no out-of-pocket cost to beneficiaries when provided by enrolled providers. To ensure accurate reimbursement and compliance with Medicare guidelines, it's essential to understand how to properly report flu vaccine services using the correct CPT and ICD-10-CM codes.

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Covered services

Screening and Billing for Maternal Depression

Postpartum depression occurs in up to 20% of women who have recently given birth, and it is estimated that fewer than half of the cases are recognized. Since not all women attend their postpartum care visit, it’s particularly important to screen new mothers for postpartum depression as part of their baby’s well visits.

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Policy refresher

Medicaid Billing for Treatment of the Prostate

A variety of minimally invasive therapies and surgeries are available for treatment of enlarged prostates. Highmark Wholecare’s Treatment of the Prostate Clinical Medical Policy  details the procedures that may be covered if following the criteria and diagnosis requirements outlined for medical necessity.

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Important information

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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

 

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

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This information is issued on behalf of Gateway Health Plan, Inc. d/b/a Highmark Wholecare, 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

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