Provider Resource Center

[{"id":453,"versionId":5,"title":"Hepatitis B and Hepatitis C Training Banner","type":4,"subType":null,"childSubType":"","date":"7/9/2024","endDate":null,"additionalDate":null,"imageUrl":null,"url":null,"baseUrl":null,"urlText":null,"description":"\u003cp\u003e\u003ca href=\"https://wholecare.highmarkprc.com/Provider-Newsletters/Wholecare-Newsfeed/450/Free-Hepatitis-B-Hepatitis-C-Training-for-Perinatal-Pediatric-Providers\"\u003e\u003cstrong\u003eTraining Opportunity for Perinatal and Pediatric Providers:\u003c/strong\u003e\u003c/a\u003e A free webinar outlining prenatal and pediatric Hepatitis B and Hepatitis C best practices will be held on July 17 from 1:00-2:30 p.m. Click \u003ca href=\"https://www.maaetc.org/events/view/26427\"\u003e\u003cstrong\u003ehere\u003c/strong\u003e\u003c/a\u003e to register!\u003c/p\u003e","longDescription":null,"visible":false,"archive":false,"liveStatus":2},{"id":434,"versionId":5,"title":"Clinical Services Referral Guide","type":4,"subType":null,"childSubType":"","date":"6/10/2024","endDate":null,"additionalDate":null,"imageUrl":null,"url":null,"baseUrl":null,"urlText":null,"description":"\u003cp\u003eHighmark 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 \u003ca href=\"https://content.highmarkprc.com/Files/Wholecare/Forms/ClinicalServicesReferralGuide.pdf\"\u003e2024 Clinical Services Referral Guide\u003c/a\u003e\u0026nbsp;is now available for providers to review the programs accessible to their Highmark Wholecare patients.\u003c/p\u003e","longDescription":null,"visible":false,"archive":false,"liveStatus":2},{"id":392,"versionId":5,"title":"UM Transitions","type":4,"subType":null,"childSubType":"","date":"3/26/2024","endDate":null,"additionalDate":null,"imageUrl":null,"url":null,"baseUrl":null,"urlText":null,"description":"\u003cp\u003e\u003cstrong\u003eImportant UM Authorization Updates:\u003c/strong\u003e\u0026nbsp;Effective May 1st, there\u0026nbsp;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:\u003cstrong\u003e \u003cu\u003e\u003ca href=\"https://wholecare.highmarkprc.com/Provider-Newsletters/Wholecare-Newsfeed/391/New-Authorization-Requirements-for-Musculoskeletal-Pain-Management-Diagnostic-Imaging-and-Physical-Medicine\"\u003eMusculoskeletal/Pain Management, Diagnostic Imaging and Physical Medicine\u003c/a\u003e;\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u0026nbsp;\u003cstrong\u003e\u003cu\u003e\u003ca href=\"https://wholecare.highmarkprc.com/Provider-Newsletters/Wholecare-Newsfeed/390/New-Authorization-Process-for-Family-Planning\"\u003eFamily Planning\u003c/a\u003e;\u0026nbsp;\u003c/u\u003e\u0026nbsp;\u003cu\u003e\u003ca href=\"https://wholecare.highmarkprc.com/Provider-Newsletters/Wholecare-Newsfeed/389/New-Authorization-Requirements-for-Cardiology\"\u003eCardiology\u003c/a\u003e\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e","longDescription":null,"visible":false,"archive":false,"liveStatus":2},{"id":356,"versionId":5,"title":"Prior Authorization Updates","type":4,"subType":null,"childSubType":"","date":"2/12/2024","endDate":null,"additionalDate":null,"imageUrl":null,"url":null,"baseUrl":null,"urlText":null,"description":"\u003cp\u003e\u003cstrong\u003e\u003cspan\u003eEffective 7/1:\u003c/span\u003e\u003c/strong\u003e\u003cspan\u003eServices requiring prior authorization from Highmark Wholecare\u0027s 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 \u003cstrong\u003e\u003cu\u003e\u003ca href=\"https://wholecare.highmarkprc.com/Provider-Newsletters/Wholecare-Newsfeed/378/UM-Fax-Number-Changes\"\u003eUM fax numbers\u003c/a\u003e\u003c/u\u003e\u003c/strong\u003e. Shift care providers and services requiring authorization through HealthHelp \u0026amp; OncoHealth will continue to follow the current process.\u003c/span\u003e\u003c/p\u003e","longDescription":null,"visible":false,"archive":false,"liveStatus":2},{"id":289,"versionId":5,"title":"E-Subscribe Provider Website Banner","type":4,"subType":null,"childSubType":"","date":"12/6/2023","endDate":null,"additionalDate":null,"imageUrl":null,"url":null,"baseUrl":null,"urlText":null,"description":"\u003cp\u003eThe Highmark Wholecare Provider Newsletter has been replaced with the \u003cstrong\u003e\u003cem\u003eProvider News\u003c/em\u003e monthly email\u003c/strong\u003e. The \u003cem\u003eProvider News\u003c/em\u003e email will become our primary communications channel, allowing us to consolidate and simplify updates for you each month. \u003ca href=\"https://wholecare.highmarkprc.com/e-Subscribe-for-Publications-and-Notifications\"\u003eSubscribe here\u003c/a\u003e to stay up-to-date with Highmark Wholecare member programs, provider policies, claims, reimbursement, and more!\u003c/p\u003e","longDescription":null,"visible":false,"archive":false,"liveStatus":2}]

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1/23/2024

It’s CAHPS® Season

Highmark Wholecare members will be receiving their Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys in early 2024. This survey will assess patient experiences with their healthcare, including overall satisfaction with network primary care providers and specialists like you!

CAHPS surveys are conducted annually in accordance with federal and state requirements. Results of the CAHPS surveys are an integral part of efforts to improve healthcare in the United States and are used to calculate a health plan’s NCQA accreditation score and Medicare Advantage Star Ratings. Additionally, Highmark Wholecare uses its CAHPS results to improve the services we offer and to keep providers informed about our performance and how they can help deliver better care. Results from the 2024 survey and related CAHPS activities will be made available to network providers. Results from the 2023 survey can be found here.

How Providers Are Rated

Getting Appointments and Care Quickly - Ease of getting care and appointments as soon as needed and being seen in a timely manner based on appointment time.
Rating of Health Care - Scaled rating of personal health care from 0-10 with 10 being the best.
Rating of Personal Doctor - Scaled rating of doctor from 0-10 with 10 being the best.
Getting Needed Care - Ease in getting timely care, tests, and treatments, as well as appointments with specialists.
Patient Conversation and Care Coordination - Includes use of understandable language, respectfulness, listening and awareness of patient’s care from specialists.

How You Can Make a Difference

Continue to be the champion of your patients through effective communication and accessibility.
Educate patients on how and where to get care after hours.
Ask your patients what is important to them.
Assist patients with scheduling and coordinating care between providers and specialists.
Ensure your patients follow their care plans.
Encourage your patients to complete preventive screenings and get their annual flu shot.
Ask if patients smoke or use tobacco, advise them to quit smoking, and provide resources.

You are a critical part of our members’ health care experience. We applaud and thank you for continuing to provide excellent care and accessibility!

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The following entities, which serve the noted regions, are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield. West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Health Insurance Company or Highmark Senior Solutions Company. Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield. Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield.

All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration and/or to one or more of its affiliated Blue companies.

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