Post-Acute Care Management: Authorization Process Changing

Effective March 1, 2026, Highmark Wholecare is moving the management of post-acute care services, including initial and concurrent authorizations, care coordination, and length of stay management, from Home & Community Care Transitions to the Guiding Care platform for Medicare D-SNP members.

This change will impact providers in Pennsylvania who serve Highmark Wholecare D-SNP members at the following locations: 

• Hospitals
• Skilled Nursing Facilities
• Inpatient Rehabilitation Facilities
• Long-Term Acute Care Hospitals

Simplified Authorization Submission

Starting March 1, 2026, all initial and concurrent authorization requests for post-acute care for D-SNP members must be submitted through Guiding Care, which you can access through NaviNet using single sign-on (SSO). The determination for your D-SNP member’s post-acute authorization will be readily available in Guiding Care.

If you haven't yet registered with NaviNet, we encourage you to do so here.

For additional questions, please reach out to your assigned Helion Network Performance Manager.