December 2024

Provider Directory Information Will Be Verified through the CAQH Directory Management Solution

Starting January 1, Highmark Wholecare will use the CAQH Directory Management Solution to verify provider directory information. To meet CMS and DHS requirements, providers must attest to this information every 90 days. Continue reading to learn how to complete this new attestation process.

Patient resources

Helping Patients Address Loneliness During the Holidays

The holiday season can be a lonely time for many, and a medical provider is often the first person a patient may open up to about their feelings of loneliness. Early intervention can help, and we have listed a number of Highmark Wholecare and community resources according to patient need and coverage.

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Policy refresher

Balance Billing Reminder

Highmark Wholecare would like to remind providers that seeking or requesting supplemental or additional payments from recipients for covered services is prohibited. You can learn more about this DHS requirement in our Fraud, Waste, and Abuse (FWA) section of the Medicaid and Medicare Provider Manuals.

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General education

Protecting Patients: The FDA MedWatch Program

MedWatch is the Food and Drug Administration’s (FDA) medical product safety program that monitors the safety of drugs, biologics, medical devices, and other regulated products. This reporting helps identify and address unknown risks associated with FDA-approved medical products, such as unexpected side effects, quality issues, and more.

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Vendor updates

Reminder: Highmark Wholecare Will have a New Vision Vendor

Starting January 1, Highmark Wholecare will have a new vision vender. VSP (Vision Service Plan, Inc.) will be joining our Highmark Wholecare network. If vision providers would like to continue participating with our Medicaid and Medicare D-SNP networks, please visit the VSP Provider Hub to complete the necessary registration forms and review VSP’s policies and procedures.

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Important information

• The 2025 ICD-10-CM Updates Provider Webinar is Now Available On-Demand

• Don’t Miss the HWPE 2024 Medicaid Fourth Quarter Bonus Campaign

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

• Invitation to Participate- Individualized Care Plan (ICP) and Interdisciplinary Care Team (ICT)

• Notice of Practice/Practitioner Changes

• Please Complete the Cultural Competency Data Form

• Encounters Submissions

• Medicare Parts A and B Cost Sharing

• Important Phone Numbers

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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