January 2025

Promoting Tobacco Recovery in 2025: Strategies for Successful Treatment and Reimbursement

Highmark Wholecare recognizes the impact tobacco has on the well-being of our members, particularly those who may face additional barriers to recovery. We are committed to supporting members in their individual recovery journeys and offer reimbursement for tobacco cessation counseling. Learn about eligibility for reimbursement, medication therapy, and other resources.

Covered services

FitOn Health Helps Medicare Members Achieve Fitness Goals

Highmark Wholecare’s new collaboration with FitOn Health offers our Medicare Assured members more flexibility and additional wellness perks. Through this program, members receive credits, amounting to $80 per month, that they can use to purchase a variety of fitness programs at any gym they would like. FitOn also offers a wide range of healthy perks on their website without the use of any credits.

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Patient resources

Our Special Needs Unit Has a New Name

Highmark Wholecare’s Medicaid Special Needs Unit (SNU) is now called the Enhanced Member Support Unit (EMSU). Even though we changed our name, our case management services remain the same! Keep reading to learn how the EMSU can assist your patients.

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Promoting quality

Boost Your CAHPS Scores and Your Patients' Health

Highmark Wholecare members will receive their Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys in early 2025. We have detailed some areas of focus and actionable tips to help your practice boost CAHPS scores and ultimately improve patient outcomes. And keep an eye out for more specific CAHPS resources in future 2025 Provider News emails!

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Policy reminder

Medicare Parts A and B Cost-Sharing

Highmark Wholecare Medicare Assured members also have Medicaid (Medical Assistance) or receive some assistance from the state. As a reminder, these members should not be held liable for Medicare Parts A and B cost-sharing when the appropriate state Medicaid agency is liable. Providers must accept payment from Highmark Wholecare’s Medicare Assured Plans as payment in full or bill the appropriate State source. Balance billing a dual eligible is prohibited by Federal law.

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Important information

• Annual HEDIS^® Medical Record Review Now Underway

• Highmark Wholecare Has a New Vision Vendor

• Empowering Members and Providers with Member Outreach Navigators

• Enhancing HIV Patient Outcomes Through Collaboration

• EVV Compliance Change Effective January 1

• Physician Portfolio Reports

• Obtaining Consent to Treatment Forms

• Coding Corner

• Accessibility to Care Resource for Behavioral Health Providers

• Prior Authorization Reminder

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

• Accessibility Standards

• Important Reminder: How to Help your Patients through the Medicaid Renewal Process

• Notice of Practice/Practitioner Changes

• Please Complete the Cultural Competency Data Form

• Encounters Submissions

• Important Phone Numbers

FitOn Inc. is a separate company that administers fitness benefits.

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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