October 2025

Spotlight: “Collaborating to Fight Food Insecurity”

Highmark Wholecare is addressing food insecurity and other social determinants of health by partnering with organizations statewide to eliminate barriers and build healthier and stronger communities. This collaboration offers resources for your patients to help improve their overall well-being.

Policy Update

Update Regarding Medicare Telehealth Coverage

Original Medicare telehealth coverage changes take effect October 1st, which is limiting services primarily to rural facilities. It’s important to note that Highmark Wholecare D-SNP plans will continue to provide expanded telehealth coverage for 2025 and 2026.

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Care Management

Patient Experience Spotlight: Addressing Bladder Control Issues

Addressing bladder control with your patients improves quality of life, reduces health risks, and enhances comfort. Save these tips to encourage proactive care and improve the quality of life for your patients.

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Care Management

EPSDT Hearing Screening

Checking for hearing loss in children is an important part of preventing negative impacts on communication development and educational performance. Ensure early detection of hearing loss through regular screenings.

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Process Update

Prescriber Notice: Diagnosis Code Requirement for Certain Medications

Highmark Wholecare reminds providers to include the corresponding ICD-10 diagnosis code with all billed medical encounters involving prescribed maintenance medications annually, in adherence to compliance and regulatory requirements. Read more about important drug classes that are flagged for review.

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Important information

Upcoming Provider Webinar: Provider Claim Education

Medicare and Medicaid Update

Protect Pennsylvania's Children from Lead Poisoning

Medicaid Provider Update: High-Cost Medicaid Drug Billing

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

PRC Site Update

Upcoming Provider Webinar: Navigating Telehealth – Best Practices for Virtual Care

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

• Policy Updates

• Accessibility Standards

• Notice of Practice/Practitioner Changes

• Please Complete the Cultural Competency Data Form

• Encounters Submissions

• Medicare Parts A and B Cost-Sharing

• 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, click here. For Central or Southeastern PA, click here.

This information is issued on behalf of Gateway Health Plan, Inc. d/b/a Highmark Wholecare, 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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