June 2026

Important Reminder: Provider Appeal Form for Fax and Mail Submissions

Highmark Wholecare reminds providers when submitting a post-service appeal by fax or mail, the Provider Appeals Form must be completed. If providers do not submit the form, the appeal will be cancelled.

Program Update

Enhanced Community Care Management Rename to “Well in Place”

Enhanced Community Care Management (ECCM) will be renamed to “Well in Place” in July. This update does not affect other components of the program and is solely a rename to better align with Highmark Wholecare’s commitment to transforming healthcare and creating a more holistic experience for members experiencing serious illness or complex conditions.

Read more ➞

Care Management

Enhancing Children’s Oral Health: The Power of Fluoride Varnish in Primary Care

Early Childhood Caries (ECC) affects many children in the US from ages 2-5, and providers are encouraged to integrate fluoride varnish application into well-child visits. Read more about the benefits of fluoride varnish and access valuable resources for your patients.

Read more ➞

Promoting Quality

Improving Access to Care for People with Disabilities

Advocating for accessible healthcare and achieving health equity for individuals with disabilities is encouraged for all providers. To support this, The Centers for Medicaid and Medicare Services (CMS) developed a guide to improve accessibility and provide multiple resources for providers and their patients.

Read more ➞

Annual Training

Model of Care Training

Highmark Wholecare providers are required to complete and attest to Model of Care (MOC) training on an annual basis. The training focuses on the SNP Provider Network section and outlines what is expected from providers to maintain an effective MOC in the new year.

Read more ➞

Important information

Prior Authorization and Medical Policy Updates

Medicaid: Coverage for Community Health Worker Services

Updated Language Data for our Medicaid Population

Maximizing Back to School Patient Visits to Boost Overall Health

Recognizing and Responding to Trauma: June is PTSD Awareness Month

Clinical Practice and Preventive Health Guidelines

Provider Self-Audits

Electronic Visit Verification Training

Ensuring Quality Care and Service through our QI/UM Program

Highmark Wholecare Practitioner Excellence Incentive Program

Invitation to Participate: Individualized Care Plan (ICP) and Interdisciplinary Care Team (ICT)

Prescriber Notice: Diagnosis Code Requirement for Certain Medications

Member Rights and Responsibilities

Accessibility to Care Resource for Behavioral Health Providers

Medicare Parts A and B Cost-Sharing

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

• Notice of Practice/Practitioner Changes

• Cultural Competency

• Encounter Submissions

• Important Phone Numbers

The information in this newsletter is for Highmark Wholecare providers. For updates specific to Commercial and Medicare Advantage in Western or Northeastern PA, or Central or Southeastern PA, click here.

This information is issued on behalf of Gateway Health Plan, Inc. d/b/a Highmark Wholecare, an independent licensee of the Blue Cross Blue Shield Association. Highmark Wholecare provides Medicaid coverage for Blue Shield in 14 counties in central PA and Blue Cross Blue Shield in 14 counties in western PA. Highmark Wholecare provides Medicare Dual-Eligible Special Needs Plans (HMO D-SNP) for Blue Shield in 17 counties in northeastern PA, 13 counties in central PA, 5 counties in southeastern PA, and for Blue Cross Blue Shield in 27 counties in western PA. Highmark Wholecare offers HMO plans with a Medicare Contract. Enrollment in these plans depends on contract renewal.

Highmark Wholecare, 120 Fifth Ave., Pittsburgh, PA 15222

Privacy Policy | Non‑Discrimination Policy