Prior Authorization Updates

As of January 1, Highmark Wholecare no longer requires prior authorization for over 200 services. This move is meant to reduce administrative burden for our provider network. The listing of affected Medicare and Medicaid services can be found here.

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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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Providers 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 here.

Model of Care Reminder for Medicare providers

As of January 1, Highmark Wholecare no longer requires prior authorization for over 200 services. This move is meant to reduce administrative burden for our provider network. The listing of affected Medicare and Medicaid services can be found here.

Mediciad Redetermination

There are members who may still be eligible for Medicaid but are being disenrolled due to failure to renew or provide the required documentation. To assist with identifying affected patients, please view the expanded PCP Medical Assistance (MA) Renewal Report in our provider portal, via NaviNet. Additionally, this flyer (English, Spanish) can help patients who have been disenrolled from Highmark Wholecare Medicaid coverage.

 

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