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Starting in December, the Highmark Wholecare Provider Newsletter is being 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 will have access to a new Clinical Platform, GuidingCare, starting January 1, 2024. This platform will allow access to an Authorization Portal via NaviNet. To learn more about accessing this new platform, please review the provider guide found here.

Model of Care Reminder for Medicare providers

As a Special Needs Plan (SNP), Highmark Wholecare is required to administer a Model of Care Plan (MOC) that will allow our Medicare Advantage Organization to provide coordinated care for special needs individuals. Highmark Wholecare expects all network practicing providers to receive MOC training annually. To access the full training document and sign your attestation, click 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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