February 2025

Changes You Should Know about the Adult Pneumococcal Vaccination

The Centers for Disease Control and Prevention (CDC) has broadened vaccination recommendations, and a new adult pneumococcal vaccine has entered the market. These changes introduce additional nuances when selecting the appropriate vaccine for each patient. Read on to learn about the new vaccine, choosing the right vaccine for each individual, and Highmark Wholecare coverage.

Promoting quality

Earn More Through the HWPE Incentive Program

The 2025 Highmark Wholecare Practitioner Excellence (HWPE) Incentive Program will go live on March 1. This Program supports Highmark Wholecare’s mission to improve the health and wellness of the individuals and the communities we serve by providing access to integrated, superior health care. We will be offering upcoming webinars for you to learn more!

Read more 

Patient resources

Our Medical Respite Program Offers Members a Safe Place for Recovery

Highmark Wholecare’s Medical Respite program provides recuperative care to Medicaid and Medicare members experiencing homelessness and in need of a safe environment following an inpatient hospitalization. Available to members discharged from various hospitals in the Pittsburgh area, this program ensures individuals continue to get care needed for recovery and connects them with additional resources.

Read more 

General education

Highmark Wholecare Highlights National Drug and Alcohol Facts Week^®

National Drug and Alcohol Facts Week^® (NDAFW) takes place March 17-23 and provides a crucial opportunity to address substance use and substance use disorder (SUD). This article highlights some key facts to help care for your patients who have a substance use disorder. Additionally, you can read more about SUD care in our Actionable Steps for Black Balloon Day article found later in this email.

Read more 

Covered services

Universal Blood Lead Toxicity Testing

Our Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit requires universal blood lead toxicity testing for children at various ages. If the screening identifies an Elevated Blood Lead Level (EBLL), the CDC and Highmark Wholecare recommend various steps be taken, such as follow-up tests and identifying the source of lead contamination.

Read more 

Important information

• Coordinating with Case Management: Release of Information Not Needed for Certain Discussions

• Medicaid EVV: Netsmart Access Ends April 30, 2025

• Medicaid Members Have Access to MHV Programs

• Mark Your Calendar for the 2025 Provider FWA Training

• Actionable Steps for Black Balloon Day

• Cotiviti Claims Pattern Review (CPR) Appeals Process

• Provider Directory Information is Verified through CAQH

• CAHPS Cues: Improving Access to Appointments

• Annual HEDIS^® Medical Record Review Now Underway

• Coding Corner

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 to Care Resource for Behavioral Health Providers

• 2025 Model of Care Overview

• 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

Privacy Policy | Non‑Discrimination Policy