March 2026

2026 Highmark Wholecare Practitioner Excellence Program

The 2026 Highmark Wholecare Practitioner Excellence (HWPE) Incentive Program has officially launched for you to participate and is hosting live webinars to answer any questions you may have about the program. For more information about opting in and participating, visit our Provider Resource Center (PRC).

Annual Training

2026 Annual Online Provider Education and Orientation Training

The Highmark Wholecare 2026 Annual Online Provider Education and Orientation Training is now available! Visit our Provider Resource Center (PRC) to see what will be covered, and how to access the training.

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Member Benefits Update

DHS Expands Maternal Home Visitation Eligibility to 24 Months

Highmark Wholecare's Maternal Home Visitation Programs now extend eligibility from prenatal care until the child is 24 months old, per a new Department of Human Services (DHS) mandate. Read more about the program, who is eligible, and how to refer your patients.

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Audit Notification

Annual Accessibility Audit

Highmark collaborates with Press Ganey annually to audit primary care and specialist practices for adherence to timely care standards through phone interviews during and after business hours, assessing appointment scheduling wait times and the effectiveness of after-hours protocols. To best prepare, review the Medicaid and Medicare Accessibility to Care Standards.

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Billing Reminder

Medicare Parts A and B Cost-Sharing

Continue to stay aware of regulations regarding cost-sharing and member rights for Highmark Wholecare Medicare Assured members who also have Medicaid. Review the Medicare Parts A and B Cost-Sharing article to learn more about accessing important member information, how to navigate these plans effectively, and ensure compliance with federal law.

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Important Information

Prior Authorization and Medical Policy Updates

Asynchronous Telemedicine Services

Risk Adjustment: Importance of HCC Gap Closures

Fraud, Waste and Abuse Audits and Medical Record Request Standards

2026 Provider Fraud, Waste, and Abuse Training

Environmental Lead Investigation Services

Post-Acute Care Management: Authorization Process Has Changed

Prescriber Notice: Diagnosis Code Requirement for Certain Medications

Invitation to Participate: Individualized Care Plan and Interdisciplinary Care Team

Annual HEDIS Medical Record Review

Model of Care Training

How to Help your Patients through the Medicaid Renewal Process

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

• Notice of Practice/Practitioner Changes

• Cultural Competency Data Form

• Encounters 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

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