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
- Provider Resource Center: https://wholecare.highmarkprc.com/
- Highmark Wholecare Main Site: https://www.highmark.com/wholecare
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