Empowering Members and Providers with Member Outreach Navigators

Highmark Wholecare offers our members access to Member Outreach Navigators, who can help them better understand their health care benefits and appropriately access services within a managed health care plan. Highmark Wholecare providers are invited to request assistance from a Member Outreach Navigator, who can supply additional education to members who need further explanation on various aspects of care, such as utilizing the emergency room appropriately.

Providers can refer Highmark Wholecare members for additional guidance adhering to their treatment plan, assistance with keeping scheduled appointments, understanding their benefits, and resources available by completing a Member Outreach Form. A Highmark Wholecare representative will contact the member and follow-up with the provider at the provider’s request.

For more information or to request member outreach, please call Highmark Wholecare’s Case Management Department at 1-800-392-1147. You can also fax the Member Outreach Form to the Case Management Department at (888) 225-2360.

Providers must complete their missed appointment outreach prior to sending in the Member Outreach Form for a missed appointment. Missed Appointment Outreach includes three attempts with at least one telephone call per missed appointment.