Highmark Wholecare Provider Portal: Secure Access for Healthcare Professionals

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Highmark Wholecare offers a robust Provider Resource Center designed to streamline communication and support for healthcare professionals serving Medicaid and Medicare populations across Pennsylvania. The provider portal serves as a critical digital platform connecting healthcare providers with essential resources and administrative tools.

Official Links

What Providers Can Do

The Highmark Wholecare Provider Portal offers multiple functionalities for healthcare professionals:

Key Portal Features

  • Access Provider Manuals
  • Navigate Medicare and Medicaid Resource Centers
  • Search Payment Policies
  • Utilize Message Center
  • Complete Provider Directory Information
  • Access Provider Newsletters
  • Verify Provider Credentials

Who Can Use the Portal

The portal is specifically designed for:

  • Medicare Providers
  • Medicaid Providers
  • Healthcare Professionals
  • Network Practitioners

Accessing the Portal

While specific login details aren’t explicitly outlined in the source materials, providers can typically:

  • Visit the official Provider Resource Center website
  • Click on designated login areas
  • Use professional credentials

Recent Portal Updates

CAQH Directory Management

As of January 15, 2025, Highmark Wholecare implemented a new directory verification process:

  • Providers must verify directory information every 90 days
  • Utilizing CAQH Directory Management Solution
  • Simplifies provider attestation process

Annual Provider Training

  • 2025 Annual Provider Education available on-demand
  • Covers claims, prior authorization, self-service tools
  • Accessible at provider’s convenience

Privacy and Security

The portal emphasizes:

  • Compliance with CMS and DHS requirements
  • Secure information management
  • Protection of provider and member data

Customer Support

Provider Support Contact:

  • Direct access to provider resources
  • Assistance with portal navigation
  • Technical support availability

Additional Resources

Provider Notifications

Providers can:

  • Subscribe to monthly Provider News email
  • Stay updated on member programs
  • Receive policy and claims information updates

Unprovided Information

Some specific details not explicitly confirmed in source materials include:

  • Exact login procedure
  • Detailed step-by-step portal navigation
  • Comprehensive list of all portal features

The Highmark Wholecare Provider Portal represents a comprehensive digital solution for healthcare professionals, offering streamlined access to critical resources, training, and administrative tools across Pennsylvania’s Medicare and Medicaid networks.

Quick Facts

  • Serves providers in multiple Pennsylvania counties
  • Supports Medicare and Medicaid networks
  • Continuous updates and improvements
  • Focuses on simplifying provider interactions

Note: Always refer to the official Highmark Wholecare website for the most current information and specific portal access instructions.

FAQ

What is the new name for Highmark Wholecare?In addition to an improved member experience, consumers will be able to select Highmark Wholecare Medicare and Medicaid products branded Blue Cross and/or Blue Shield. Highmark Wholecare is the new trade name for Gateway Health and its products were formerly offered as Gateway Health products.

What kind of Health insurance is Highmark Wholecare?Highmark Wholecare serves a Medicaid plan to Blue Shield members in 13 counties in central Pennsylvania, as well as to Blue Cross Blue Shield members in 14 counties in western Pennsylvania.

Is Highmark Wholecare the same as Gateway?Highmark Wholecare Medicare Plans. Highmark Wholecare, an independent licensee of the Blue Cross Blue Shield Association and formerly known as Gateway Health Plan, was founded in 1992 to provide customers with an alternative to the Pennsylvania Department of Welfare Medical Assistance Program.

Are Blue Cross Blue Shield, and Highmark the same?Highmark Inc. is an independent licensee of the Blue Cross Blue Shield Association.

https://wholecare.highmarkprc.com/

Find your Medicaid and Medicare solution in Pennsylvania with Highmark Wholecare. Choose from our comprehensive health insurance plans for reliable care.

https://www.highmark.com/wholecare

Highmark’s Provider Resource Center is your source for all provider-related information and updates. The PRC offers resources to assist in the treatment of

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