Provider Resource Center

[{"id":409,"versionId":5,"title":"Annual Provider Training","type":4,"subType":null,"childSubType":"","date":"5/1/2024","endDate":null,"additionalDate":null,"imageUrl":null,"url":null,"baseUrl":null,"urlText":null,"description":"\u003cp\u003eHighmark 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 \u003cstrong\u003e\u003ca href=\"https://www.brainshark.com/1/player/highmarkmedicaid?pi=zKFzuRilozibduz0\u0026amp;r3f1=18225c0f030e5644145e224717161e0d195e0722411c1b100d195059384b5510120144\u0026amp;fb=0\"\u003ehere.\u003c/a\u003e\u003c/strong\u003e\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":383,"versionId":5,"title":"Change Healthcare Cyber Incident Banner","type":4,"subType":null,"childSubType":"","date":"3/19/2024","endDate":null,"additionalDate":null,"imageUrl":null,"url":null,"baseUrl":null,"urlText":null,"description":"\u003cp\u003eImportant Provider Notice - March 5, 2024 - Change Healthcare Event: Highmark Wholecare Claims/Remittance Update\u0026nbsp;-\u0026nbsp;\u003ca href=\"https://content.highmarkprc.com/Files/Wholecare/Forms/BS_Wholecare%20Provider%20Notification%20Change%20Healthcare%20Update%20FINAL%203.5.24%20245pm.pdf\"\u003ePlease click here for more information.\u003c/a\u003e\u0026nbsp;Additionally, to learn more about how Highmark Wholecare is assisting providers impacted by the Change Healthcare cyber event, click \u003ca href=\"https://wholecare.highmarkprc.com/Provider-Newsletters/Wholecare-Newsfeed/382/Assistance-for-Highmark-Wholecare-Participating-Providers-Impacted-by-Change-Healthcare-Cyber-Event\"\u003ehere.\u003c/a\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},{"id":287,"versionId":5,"title":"GuidingCare Provider Website Banner","type":4,"subType":null,"childSubType":"","date":"11/30/2023","endDate":null,"additionalDate":null,"imageUrl":null,"url":null,"baseUrl":null,"urlText":null,"description":"\u003cp style=\"margin: 0in;\"\u003eProviders now have access to a new Clinical Platform, GuidingCare. This platform allows access to an Authorization Portal via NaviNet. Please utilize this online capability as the preferred method to submit your authorization requests. To learn more about accessing this new platform, please review the provider guide \u003ca href=\"https://content.highmarkprc.com/Files/Wholecare/docs/GuidingCareUserGuide.pdf\"\u003ehere\u003c/a\u003e.\u003co:p\u003e\u003c/o:p\u003e\u003c/p\u003e","longDescription":null,"visible":false,"archive":false,"liveStatus":2}]

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4/22/2024

Join the Fight Against Antibiotic Resistance

Antibiotic resistance impacts all global regions and populations. Highmark Wholecare asks our network providers to help us enforce the proper use of antibiotics to fight accelerating antibiotic resistance among the population. While this resistance does occur naturally, the inappropriate use of antibiotics will also reduce the efficacy of antibiotics, causing common infections to become more serious and persistent.

Several infections have been impacted by the overuse of antibiotics such as: gonorrhea, salmonellosis, and pneumonia, resulting in longer hospital stays, increased medical costs, and even mortality rate increases. Additionally, research shows an increased amount of evidence that antibiotics are used improperly when treating a wide range of other illnesses. For example, studies have shown that more than half of prescribed antibiotics are not necessary.

Antibiotics are also commonly sought after for illnesses caused by viruses rather than bacteria such as colds, sore throat, whooping cough, and urinary tract infractions. Pharyngitis is a condition for which antibiotics are often erroneously prescribed - more than 80% of cases that are viral-based are treated with an antibiotic. Similarly, when treating Otitis Media in children, antibiotics are often prescribed even if the benefits do not outweigh the drawbacks of common adverse events.

Health care professionals have a duty to only prescribe antibiotics when necessary, educate patients on how to take antibiotics properly, and encourage patients to engage in behaviors that prevent infections, such as proper handwashing, vaccinations, and practicing safe sex. Patients should be encouraged to only use antibiotics as prescribed and follow physician direction when antibiotics are deemed unnecessary.

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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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