May 2026

Medicaid: Community Health Worker Enrollment and Billing Instructions

Community Health Workers (CHWs) can now enroll in the Medical Assistance Program to render services to managed care beneficiaries. Click the link below for additional information about this update and billing instructions.

Care Management

May is Mental Health Awareness Month

May is Mental Health Awareness Month. Through increasing awareness of mental health, fostering empathy, screening patients for mental concerns, and promoting treatment and support, providers can make a monumental impact.  Read more to gain insight on tips and available resources for your patients.

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Patient Resources

Removing Barriers for Hospital Discharge Transportation

The Medical Assistance Transportation Program (MATP) ensures eligible patients receive timely and safe transportation home within 24 hours of hospital discharge, including urgent after-hour requests.  Read more to learn about what happens if the arrangements cannot be made and what options are available.

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Coding and Claims

Modifier SA Reporting Guidelines for both Medicaid and DSNP

Learn more about how to properly bill for services provided by Advanced Practice Providers (APPs) to ensure accurate reimbursement and avoid claim denials. The “Incident To” Billing policy with the required use of Modifier SA, is important for compliant claim submissions.

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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.

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Important information

Prior Authorization and Medical Policy Updates

Vision Screening and Billing with Highmark Wholecare

Cotiviti Pre-Payment Claims Pattern Review

Highmark Wholecare Practitioner Excellence Incentive Program: Care Gap Management Application is Now Live

Prescriber Notice: Diagnosis Code Requirement for Certain Medications

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.

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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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