September 2024

Flu Season has Arrived

You can help us protect our members, your patients, during the upcoming flu season by educating them on the benefits of receiving a flu shot. Many of our members have chronic conditions that put them at an even greater risk of complications from the flu, which makes vaccination for this population even more important.

Vendor updates

Highmark Wholecare Will Have a New Vision Vendor Starting January 1

We’re excited to announce that VSP (Vision Service Plan, Inc.) will be joining the Highmark Wholecare network. VSP will be taking over from our current vision vendor, and existing vision providers who wish to continue participating in the Highmark Wholecare network can visit VSP’s Provider Hub to join the VSP network. Additionally, you can learn about Vision Screening and Billing with Highmark Wholecare in our article.

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Events and training

EVV Vendor Update and Upcoming Training Sessions

Highmark Wholecare will be transitioning our payer-sponsored Electronic Visit Verification (EVV) system to HHAeXchange starting November 1. Home Health providers will need to complete the Provider Onboarding Form and attend the Training Sessions to prepare for this new vendor’s go-live date. Continue reading to view a listing of upcoming training sessions and additional registration materials.

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Patient resources

Highmark Wholecare’s La Conexion Program Serves our Hispanic and Latino Members

National Hispanic Heritage Month begins September 15 and celebrates the history, traditions, contributions, and cultural diversity of Hispanic and Latino Americans. The La Conexion Program supports the care coordination and social needs of our Hispanic and Latino Highmark Wholecare members year-round through a bilingual community health worker in Reading, Pennsylvania.

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Promoting quality

2024 HWPE: Medicaid Fourth Quarter Bonus Campaign

Providers who participate in the Highmark Wholecare Practitioner Excellence (HWPE) Program can earn extra for closing care gaps in the fourth quarter. For select measures, an additional $200 reward will be available for each Medicaid member care gap closed. The deadline to opt-in to the 2024 HWPE Program is September 30.

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Important information

• Medicaid Members Have Access to MHV Programs

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

• Vision Screening and Billing with Highmark Wholecare

• Tobacco-Free Recovery is Recovery Virtual Conference

• 2024 Annual Provider Accessibility Audit Results

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

• Invitation to Participate- Individualized Care Plan (ICP) and Interdisciplinary Care Team (ICT)

• 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. La Conexion is a joint partnership between three organizations – Highmark Wholecare, Reading Hospital and Centro Hispano. Centro Hispano is a separate organization that provides life-enhancing programming for the Greater Reading community. Reading Hospital is a separate healthcare entity that provides medical care for people in need, including Highmark Wholecare members.

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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