July 2025

Important Credentialing Update

Highmark Wholecare will now individually credential Audiologists, Speech Language Pathologists, Physical Therapists, and Occupational Therapists. As a result of this change, we are requesting that affected entities submit the Credentialing Data Provider Form or the Provider Roster (if you are credentialing 10 or more providers).

Covered services

Fitness Benefit Vendor Change Occurring on Aug. 1

To help ensure members have access to a fitness program that’s reliable and easy to use, Highmark Wholecare is switching our fitness benefit vendor to SilverSneakers. Starting Aug. 1, 2025, FitOn will no longer administer our Medicare Assured fitness benefit.

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Care management

July is Black, Indigenous, People of Color (BIPOC) Mental Health Awareness Month

In recognition of BIPOC Mental Health Awareness Month, we're focusing on addressing critical disparities in mental health care access and outcomes. This information will help you support patients, reduce barriers to care, and access resources for our members and the wider community.

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General education

Medetomidine: What Providers Need to Know

Medetomidine, a synthetic alpha-2 adrenoreceptor agonist, has been increasingly found as an adulterant in Pennsylvania's illicit opioid supply. This drug can cause deep and prolonged sedation, miosis, bradycardia, initial hypertension followed by hypotension, and bradypnea, as well as severe and atypical withdrawal.

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Promoting quality

Physician Portfolio Reports

The biannual Physician Portfolio Reports are now available to qualifying Medicaid primary care provider practices. These reports share actionable data for various patient measures and outline network-wide performance data, highlighting specific areas where we can work together to optimize patient outcomes.

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Important information

• Provider Appeal Form Now Available for Fax and Mail Submissions

• A Message from Pennsylvania DHS

• Maximize Impact During National Immunization Awareness Month

• Updated Language Data for our Medicaid Population

• Fraud, Waste, and Abuse: Provider Routine Audit Investigations

• Screening and Billing for Anemia

• Coding Corner: Understanding External Cause Codes

• CAHPS Cues: Clear Communication for Better Care

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

• 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

SilverSneakers is a registered mark of Tivity Health Inc. Tivity Health Inc., is a separate company that administers the SilverSneakers program. 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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