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

Maximize Your Reimbursement: A Guide to Screening, Brief Intervention, & Referral to Treatment (SBIRT) Billing for Providers

Screening: The use of validated screening/ assessment to quickly assess patient substance use risk.

Brief Intervention: A 5-15-minute discussion aiming to increase patient understanding of risks and build towards behavior change.

Referral to Treatment: Providing patients with the resources and education regarding substance use treatment options that are available to them and appropriate for their needs.

Provider reimbursement for SBIRT services is available for Highmark Wholecare Medicare and Medicaid members ages 12 and older.

A prior authorization request is not required for SBIRT reimbursement.
SBIRT may be provided face-to-face with the member, through telehealth/telemedicine, or telephonically.
SBIRT is not designed to address smoking and tobacco cessation services unless it is a co-occurring diagnosis with another substance such as drugs or alcohol. Tobacco-only services are not a SBIRT billable benefit.
SBIRT screenings/assessments are reimbursable as many times as needed for each patient, with the exception of code H0049, which is reimbursable up to twice per year for each patient.

Highmark Wholecare offers additional self-paced trainings on SBIRT and other substance use related topics with free CEs, as well as resources to assist in this process. Please contact Shannen Lauffer at Slauffer@HighmarkWholecare.com for more information.

Wondering how to Bill?

Providers interested in accessing the Highmark Wholecare SBIRT Billing Guide for more information please click here.

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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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