July 2024

Maximize Back to School Patient Visits to Boost Overall Health

It’s back to school season, and many of our members will schedule their annual wellness visits and sports physicals to prepare for the new year. In addition to assessing current health, these visits offer valuable opportunities to proactively address potential health concerns, encourage healthy habits, and close care gaps.

Our processes

Highmark Wholecare will Continue to Utilize NaviNet

Highmark Wholecare will continue to use NaviNet as our provider portal. Unlike Highmark, we will not be transitioning to another portal system. Continue reading to learn about the various self-service tasks you can complete through NaviNet.

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Our providers

Medicare’s Mental Health Coverage: Updates to Eligible Professionals

Beginning January 1, 2024, the Centers for Medicare and Medicaid Services (CMS) added Marriage and Family Therapists and Mental Health Counselors to the list of eligible professionals. Click below to read more about what this means for you and your patients.

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Covered services

How to Screen and Bill for Anemia with Highmark Wholecare

Screening for anemia is an important aspect of health care in children and infants. If not addressed, iron deficiency and iron deficiency anemia can have adverse effects on neurodevelopment. This article outlines when to screen children for anemia and how to bill for these screenings.

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Care management

Ensuring Members Receive Needed Care During the GLP-1 Shortage

The ongoing GLP-1 shortage is impacting diabetes care and creating challenges for both patients and providers. We are committed to working collaboratively with you to ensure our members with diabetes continue receiving the care they need. Read more to learn how we can work together on this effort.

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Important information

• Highmark Wholecare Provides SDoH Resources for Members

• How to Screen and Bill for Adolescent Depression with Highmark Wholecare

• Provider Claim Education Webinar: 2024 CPT Updates & Highlights Available On-Demand

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

• How to Help your Patients through the Medicaid Renewal Process

• 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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