Reminder: SSBCI Qualification Requirement for Highmark Wholecare D-SNP Members in 2026

Highmark Wholecare offers additional benefits to SSBCI-eligible members. We are working to qualify our members via claims history and risk analysis. Many are already qualified. As a Highmark Wholecare provider, you can help those who are not yet qualified get these benefits faster by completing a SSBCI Provider Attestation form, upon your patient’s request, and submitting it back to us. CMS requires that a member’s chronic condition and risk of adverse health outcomes be documented for members to receive this type of benefit. This form confirms their health needs and medical condition(s) and helps Highmark Wholecare quickly activate their extra benefits.

SSBCI Benefit Provider Attestation Form and Instructions:

1. Download the SSBCI Provider Attestation Form.
2. Submit the completed form back to us via fax at 844-246-1353. Your patient will receive a qualified/non-qualified communication once Highmark Wholecare completes the processing of the completed provider attestation form. There is no further action needed by you after the form is submitted.

You can help Highmark Wholecare qualify our Dual Eligible members for these benefits by documenting proper diagnosis codes in the patient's chart for qualifying conditions and ensuring medical claims contain all applicable diagnoses coded to the highest level of specificity.

How You Can Support Your Patients

• During Annual Enrollment: Remind patients about the Medicare Annual Enrollment Period (October 15 – December 7) and to watch for their qualified or non-qualified notice from Highmark Wholecare in October/November 2025.
• Discuss Implications: Encourage patients to consider how these changes impact their care and benefits. Highmark Wholecare’s qualifying conditions are broad, and it is likely they will be eligible to receive SSBCI food/utility benefits once you submit their Attestation.
  • Patient Impact: To ensure continuity of valuable supplemental benefits, patients are encouraged to stay with their current plan or understand the impact of switching. Switching plans may delay access to these extra benefits due to going through the qualification process again, while staying in the same plan could allow quick qualification for SSBCI food/utility benefits.
• Highmark Wholecare Resources: Direct patients to Highmark Wholecare Member Services by calling the number on the back of their ID card for more information and support on their qualification status.
• Patient Attestation Requests: Please complete an office visit and the Provider Attestation form (available on the Highmark Wholecare Provider Resource Center under Medicare Resources) and fax back to Highmark Wholecare so your patient’s qualification determination for these valuable benefits is completed as quickly as possible.