August 2024

International Overdose Awareness Day: A Call to Action for Health Care Professionals

International Overdose Awareness Day is observed August 31 and serves as a reminder about the impacts of drug overdose. Health care professionals play a vital role in preventing and responding to drug overdose through early identification and risk assessment, patient education, and referral to treatment when necessary.

Promoting quality

CAHPS Satisfaction Scores Are In

Highmark Wholecare distributed the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey to randomly selected members earlier this year. Continue reading to learn about member feedback on their health care and how we can improve the patient experience together.

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Covered services

Hearing Screening and Billing with Highmark Wholecare

Hearing loss is the most common congenital condition in the United States, and hearing impairment during childhood can impact communication, development, and educational performance. This article outlines the cadence that providers should conduct hearing screenings and how to bill for them with Highmark Wholecare.

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Promoting quality

Physician Portfolio Reports Now Available

Through our Physician Portfolio Reports, Highmark Wholecare shares data and facilitates ongoing conversations with providers to continually improve the quality of member care. Eligible primary care practices who serve our Medicaid members now have access to the July report via NaviNet.

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Events and training

Claim Education: New Patient Vs. Established Patient Webinar

Highmark Wholecare is hosting a live claims educational webinar on September 4 at 12 p.m. The training will provide updated guidance on new patients vs. established patients and how to apply this when billing. You can register for the training on our provider website.

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Important information

• Important Electronic Visit Verification (EVV) Vendor Update

• Annual Provider Accessibility Audit Complete: Next Steps for Provider Practice Sites

• Updated Language Data for our Medicaid Population

• CMS Requirements and Credentialing for Psychological Services

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

• Policy Updates

• Model of Care Training Summary

• Notice of Practice/Practitioner Changes

• Please Complete the Cultural Competency Data Form

• Encounters Submissions

• Medicare Parts A and B Cost Sharing

• Important Phone Numbers

NaviNet^® is a separate company that provides an internet-based application for providers to streamline data exchanges between their offices and Highmark Wholecare such as routine eligibility, benefits and claims status inquiries.

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

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