June 2025

How to Help Patients Affected by Rite Aid Pharmacy Closures

Rite Aid has announced the closure of over 150 Pennsylvania pharmacy locations that will no longer be available to our members. Providers can assist impacted Highmark Wholecare patients in finding alternative pharmacies by visiting our website and selecting “Find a Pharmacy” or directing members to call the Member Services number on the back of their insurance card.

Care management

Highmark Wholecare’s 2025 Clinical Programs Streamline Care and Improve Health Outcomes

Our 2025 Clinical Services Referral Guide is now available for providers. Our Clinical Services department manages a broad scope of programs that connect your eligible patients with support aimed at improving overall health outcomes while reducing your administrative burden.

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Care management

Maximizing Back to School Patient Visits to Boost Overall Health

As members start to prepare for the new school year, many will schedule their annual wellness visits and sports physicals. These visits offer valuable opportunities to assess our members’ current health and proactively address potential health concerns by closing any outstanding care gaps and ensuring patients are up to date on vaccines.

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Process updates

Reminder: Cotiviti Claims Pattern Review (CPR) Appeals Process

Highmark Wholecare now utilizes Cotiviti Claims Pattern Review (CPR) for our claims processing. Providers must utilize direct upload to the Secure Portal,  secure faxing, or mail to send in Cotiviti CPR Appeals. This article lists the requirements for each of these three options.

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Important information

• Recent Addition to Pennsylvania’s Naloxone Standing Order

• CAHPS Cues: Ensuring Doctors Have the Information They Need

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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