October 2024

2025 Highmark Wholecare Medicare Assured Benefits

Highmark Wholecare is pleased to announce several exciting benefit enhancements for Medicare plan members beginning January 2025. Benefits for next year include General Supports for Living, Transportation, Vision, and more!

Process updates

Introducing TRENDSubmit: A New Provider Self-Reporting Process for Overpayments

Providers can now electronically submit overpayments through TRENDSubmit. This secure, online process allows providers to be notified of claim retractions in real-time and eliminates the lengthy manual paper process. Learn about the federal and state requirements and this new process in the article below.

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Care management

Depression Screening Improves Patient Outcomes and Reduces Costs

Depression screening is crucial in early detection and intervention for mental health conditions. While mental health awareness has increased, the stigma surrounding depression persists, often leading to delayed diagnosis and treatment. Read more about screening for depression and resources available to Highmark Wholecare members.

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Vendor updates

Prepare for the November 1 EVV Solution Transition to HHAeXchange

As a reminder, Highmark Wholecare is transitioning our payer-sponsored Electronic Visit Verification (EVV) solution to HHAeXchange as of November 1. This applies to providers submitting claims for personal care services and home health care services. You are encouraged to complete the HHAeXchange Provider Onboarding Form and attend an open hours sessions for Post Go Live Support.

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Covered services

Dyslipidemia Screening and Billing with Highmark Wholecare

As part of the Early Periodic Screening, Diagnostic, and Testing (EPSDT) Schedule, Dyslipidemia is a Universal Screening that should occur during two age ranges and at other times if indicated by history and symptoms. The article below details screening and billing requirements for Dyslipidemia.

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Important information

• VSP Vision Reminder

• Medicaid Member Billing Policy

• 2024 Medicaid Provider Policy and Procedure Manual Now Available

• Don’t Miss the HWPE 2024 Medicaid Fourth Quarter Bonus Campaign

• Upcoming Provider Webinar: Breaking Down Behavioral Health - Coding Concepts

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

• Important Reminder: How to Help your Patients through the Medicaid Renewal Process

• Notice of Practice/Practitioner Changes

• Please Complete the Cultural Competency Data Form

• Encounters Submissions

• Medicare Parts A and B Cost Sharing

• Important Phone Numbers

VSP Vision is a separate company that administers the vision benefit(s) for Highmark Wholecare.

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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