May 2025

Disease Prevention with Childhood and Adolescent Immunizations

Recent outbreaks of measles, pertussis (whooping cough), and other vaccine-preventable diseases presents an opportunity to remind your Highmark Wholecare patients about the importance of childhood and adolescent immunizations. We are sharing some best practices to help these patients stay on track.

General education

Join the Fight Against Antibiotic Resistance

To help reduce antibiotic resistance, providers can encourage patients to use antibiotics only as prescribed and to follow provider direction when they are deemed unnecessary. While this resistance does occur naturally, the inappropriate use of antibiotics will also reduce their efficacy, causing common infections to become more serious and persistent.

Read more 

Promoting quality

Highmark Wholecare Launches Pediatric Shift Care Incentive Program

The Highmark Wholecare Practitioner Excellence (HWPE) Pediatric Shift Care Incentive Program recognizes and rewards our pediatric shift care nursing providers who demonstrate excellence in providing consistent, high-quality care to our members. Learn more about eligibility requirements, performance measures, and payment details in the following article.

Read more 

Care management

Post-Traumatic Stress Disorder (PTSD): Identifying Risk and Providing Effective Care

As you know, Post-traumatic Stress Disorder (PTSD) can affect individuals of any age following exposure to a distressing event. Research suggests a significant link between Adverse Childhood Experiences (ACEs) and the development of PTSD in adulthood. By screening patients for PTSD and ACEs, providers can better assess risk and guide appropriate interventions.

Read more 

Process updates

Upcoming Medical Record Review

As part of our contract to provide medical coverage for the Medicaid and Medicare Assured population, we are required to perform medical record audits. If your practice is selected for this review, you will be contacted by the Quality Improvement Team for support. We kindly ask for your assistance with providing copies of the supporting documentation relating to the Medical Record Review Standards.

Read more 

Important information

• Vision Screening and Billing with Highmark Wholecare

• Coding Corner: Observation Care

• Medicare Mental Health Coverage: Updates to Eligible Professionals

• Provider Webinars: Highmark Wholecare invites you to attend our 2025 Annual Provider Education and Orientation Training

• CAHPS Cues: Ensuring Easy Access to Care, Tests, and Treatment

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

• Policy Updates

• 2025 Model of Care Training Summary

• 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

Privacy Policy | Non‑Discrimination Policy