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Medicaid Provider Updates
- NOTICE OF MEDICAID POLICY UPDATES FOR SEPT 1
- MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE JUL 7
- NOTICE OF MEDICAID POLICY UPDATES FOR AUG 1
- NOTICE OF MEDICAID POLICY UPDATES FOR JULY 1
- NOTICE OF MEDICAID POLICY UPDATES FOR JUNE 1
- MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE MAY 12
- MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE APR 1
- MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE APR 1
- NOTICE OF MEDICAID POLICY UPDATES FOR APR 1
- MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE MAR 12
- NOTICE OF MEDICAID POLICY UPDATES FOR MAR 1
- MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE JAN 27
- NOTICE OF MEDICAID POLICY UPDATES FOR FEB 1
- NOTICE OF MEDICAID POLICY UPDATES FOR JAN 1
- MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE NOV 23
- NOTICE OF MEDICAID POLICY UPDATES FOR DEC 1
- NOTICE OF MEDICAID POLICY UPDATES FOR NOV 1
- NOTICE OF MEDICAID Payment Policies UPDATES FOR OCT 25
- NOTICE OF MEDICAID POLICY UPDATES FOR OCT 1
- MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE SEPT 13
- NOTICE OF MEDICAID POLICY UPDATES FOR SEPT 1
- NOTICE OF MEDICAID Payment Policies UPDATES FOR AUG 1
- NOTICE OF MEDICAID POLICY UPDATES FOR AUG 1
- NOTICE OF MEDICAID POLICY UPDATES FOR JUL 1
- NOTICE OF MEDICAID POLICY UPDATES FOR MAY 1
- MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE APR 15
- NOTICE OF MEDICAID POLICY UPDATES FOR APR 1
- NOTICE OF MEDICAID POLICY UPDATES FOR MAR 1
- NOTICE OF MEDICAID POLICY UPDATES FOR FEB 1
- Prior Authorization No Longer Required for 200+ Services
- NOTICE OF MEDICAID POLICY UPDATES FOR Jan1
- Providers Will Have Access to New Clinical Platform, GuidingCare, Starting Jan 1
- MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE DEC 18
- NOTICE OF MEDICAID POLICY UPDATES FOR Dec 1
- Webinar - Provider Claim Education: 2024 ICD-10-CM Updates & Highlights
- Highmark Wholecare has a New Address
- NOTICE OF MEDICAID POLICY UPDATES FOR Nov 1
- Physical Health- Behavioral Health Integrated Care Program Webinar
- NOTICE OF MEDICAID POLICY UPDATES FOR OCT 1
- Help Patients Continue to Receive Healthcare Coverage
- NOTICE OF MEDICAID POLICY UPDATES FOR SEPT 1
- Provider Claim Education: Evaluation & Management Edit Updates
- Claims Process Update with New Highmark Wholecare Member ID Numbers
- Medications to Require Medical Prior Authorization, Effective Aug 15
- Notice of Medicaid Policy Updates for Aug 1
- Highmark Wholecare ID Cards Changing July 2023
- Medicaid Member Lab Requirements Changing June 1
- Medicaid Member Lab Requirements Changing June 1
- Cotiviti Claims Pattern Review (CPR)
- Join Highmark Wholecare to Learn More About Medicaid Redetermination
- PCP Roster with Medicaid Redetermination Date Available in the Provider Portal
- The End of the Continuous Coverage Requirement and Impacts to Medical Assistance Coverage
- Notice of Medicaid Policy Updates for May 1
- Notice of Medicaid Policy Updates for May 1
- The End of the Continuous Coverage Requirement and Impacts to Medical Assistance Coverage
- Maternal Home Visitation (MHV) Programs
- NOTICE OF MEDICAID POLICY UPDATES FOR JUNE 1
- Notice of Medicaid Policy Updates for Apr 1
- NOTICE OF MEDICAID POLICY UPDATES FOR OCT 1
- MEDICATIONS TO REQUIRE MEDICAL PRIOR AUTHORIZATION, EFFECTIVE OCT 1
- NOTICE OF MEDICAID POLICY UPDATES FOR NOV 1
- PA Medicaid Policy Updates Effective December 1, 2025
- Medications to Require Medical Prior Authorization, Effective April 1, 2026
- Medications to Require Medical Prior Authorization - May 2026
- Medicaid Policy Search - Retired
Medicaid Policy Search - Retired
Last Updated: Wednesday, April 29, 2026
Please access the Prior Authorization Code Lookup to determine if a drug/HCPCS code requires authorization. To submit authorization requests, please visit the Highmark Wholecare Provider Portal via NaviNet: https://navinet.navimedix.com.
Name |
Type |
State |
Effective |
Medical Policy |
PA Medicaid |
03/01/2026 |
|
Medical Policy |
PA Medicaid |
12/01/2025 |
|
Medical Policy |
PA Medicaid |
11/01/2025 |
|
Endoscopic Ultrasound (EUS) and Endoscopic Retrograde Cholangiopancreatography (ERCP) |
Medical Policy |
PA Medicaid |
12/01/2025 |
Medical Policy |
PA Medicaid |
12/01/2025 |
|
Medical Policy |
PA Medicaid |
12/01/2025 |
|
Medical Policy |
PA Medicaid |
12/01/2025 |
|
Hypoglossal Nerve Stimulation Implantation in the Treatment of Obstructive Sleep Apnea |
Medical Policy |
PA Medicaid |
06/01/2026 |
Medical Policy |
PA Medicaid |
06/01/2026 |
|
Medical Policy |
PA Medicaid |
03/01/2026 |
|
Medical Policy |
PA Medicaid |
06/01/2026 |
|
Medical Policy |
PA Medicaid |
03/01/2026 |
|
Upper Gastrointestinal Endoscopy (EGD-esophagogastroduodenoscopy) |
Medical Policy |
PA Medicaid |
11/01/2025 |
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