Clinical Services Referral Guide

Highmark Wholecare has developed a robust offering of clinical programs that offer whole person care to our members and improve health outcomes. We are excited to share that the updated 2024 Clinical Services Referral Guide is now available for providers to review the programs accessible to their Highmark Wholecare patients.

Annual Provider Training

Highmark Wholecare invites providers to attend the 2024 Provider Education and Orientation Training to learn about topics such as EPSDT, access/accessibility surveys, Fraud, Waste, and Abuse, Model of care, self-service tools, Cultural Competency, claims, and more! The training is on-demand and can be viewed at your convenience. Register here.

UM Transitions

Important UM Authorization Updates: Effective May 1st, there are updates to the authorization requirements and processes for various Highmark Wholecare services. To learn more about these specific changes and to review reference materials, visit the following links: Musculoskeletal/Pain Management, Diagnostic Imaging and Physical Medicine Family Planning Cardiology

Prior Authorization Updates

Effective 7/1:Services requiring prior authorization from Highmark Wholecare's UM Department must be submitted through the GuidingCare portal in Navinet. If the portal is unavailable, you can call our UM team at 1-800-392-1147 TTY: 711 or fax the request using UM fax numbers. Shift care providers and services requiring authorization through HealthHelp & OncoHealth will continue to follow the current process.

E-Subscribe Provider Website Banner

The Highmark Wholecare Provider Newsletter has been replaced with the Provider News monthly email. The Provider News email will become our primary communications channel, allowing us to consolidate and simplify updates for you each month. Subscribe here to stay up-to-date with Highmark Wholecare member programs, provider policies, claims, reimbursement, and more!


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