March 2025

Highmark Wholecare’s Disease Management Programs

Our Disease Management Programs can help your patients manage their chronic conditions. The programs focus on identifying the needs of the population within these specific conditions and perform scheduled outreach activities to provide education, resources, and care coordination to Highmark Wholecare members.

Promoting quality

Opt-in the HWPE Incentive Program Today

The Highmark Wholecare Practitioner Excellence (HWPE) Incentive Program launched on March 1 and highlights the excellent care that Highmark Wholecare providers deliver to our membership. To further assist you in care management, the Care Gap Management Application (CGMA) offers access to important care gap information and will be available starting April 1. Continue reading to learn more.

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Patient resources

Rethinking Drinking: Alcohol Use and Standard Drink Sizes

April is Alcohol Awareness Month, which provides an opportunity to discuss alcohol consumption and its effects on patient health. Consistent use of standard drink equivalents is crucial for patient conversations and gaining accurate assessments of alcohol use and its associated risks. To assist with these conversations, this article outlines standard drink sizes and beverage containers.

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Care management

Continuity of Care Across Settings

Open communication between the different providers caring for a patient is imperative to making informed care decisions and promoting overall well-being. By sharing any reports, therapies, medications, and concerns across treatment settings, both you and your patients will benefit.

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General education

Important Updates from the PA Department of Health

These important updates include a reminder that the HPV Vaccine is recommended starting at age 9 to help reduce the number of patients contracting HPV infections, that cause cancer. Additionally, the Department of Health has announced a funding opportunity for Pennsylvania organizations implementing community-based solutions to improve maternal health outcomes and health equity.

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Important information

• Environmental Lead Investigation Services

• Enhance Your Practice and Help Your Patients with Highmark Wholecare's SBIRT Program

• Reportable Conditions

• Important Reminders and Updates for Medicaid Home Health Providers

• Reminder: 2025 Provider Fraud, Waste, and Abuse (FWA) Training

• Cotiviti Claims Pattern Review (CPR) Appeals Process

• CAHPS Cues: Reducing Wait Times at Appointments

• Coding Corner: Coding For Assisted Living Facilities

• Annual HEDIS^® Medical Record Review Now Underway

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 to Care Resource for Behavioral Health Providers

• Member Rights and Responsibilities

• 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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