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Learn more about MOM matters by: Call 1-800-392-1147. Teletypewriters (TTY) users call 711 or 1-800-654-5984. Select the option for the Special Needs Unit. Select the option for MOM Matters. The Highmark Wholecare MOM Matters program provides support and resources for pregnant women and new moms. Learn more and get connected today!We provide a variety of other health coverage products like dental, vision, and travel insurance in addition to great services like The Caring Program and fertility treatment. DISCOVER. Highmark Inc. has taken a leadership role in providing innovative products, programs, and services for our members, providers, and the communities we serve.The Highmark Wholecare physician agreement indicates that participating providers must submit written notice: Ninety (90) calendar days prior to the date the provider intends to terminate. Sixty (60) days prior if you plan to close your practice to new patients. Thirty (30) days prior for a practice location change.Call our dedicated Medicare D-SNP team to see if you qualify for Highmark Wholecare. 1-717-392-9954 TTY 711 Health benefits or health benefit administration may be provided by or through Highmark Wholecare, an independent licensee of the Blue Cross Blue Shield Association (“Highmark Wholecare”).Depending on your D-SNP, you’ll have a variety of benefits to use in addition to your medical coverage, like: Caregiver Resources. Care Transitions. Dental Services. Healthy Food Benefit. Goodness Rewards. Hearing Services. Lifestyle Management. Mental Health Services.Having a health plan means knowing what you want to achieve for your well-being. . Find the right plan that suits your needs and budget. view all plans. Login and unlock your Highmark health plan benefits. Our member guide and website provide everything you need to take charge of your health care.Highmark Blue Cross Blue Shield or Highmark Blue Shield are Medicare Advantage HMO, PPO, and/or Part D plans with a Medicare contract. Enrollment in these plans depends on contract renewal. Benefits and/or benefit administration may be provided by or through the following entities, which are independent licensees of the Blue Cross Blue Shield ...Dental Benefit Guidelines. Each Highmark Wholecare D-SNP offers its own benefit levels for dental care each year and some covered services with $0 copay. Also, D-SNP plans have different benefits for detail care, such as: Root canals. Dentures. Caps or crowns. Deep cleaning of the teeth to remove deposits under the gums (scaling and root planning)Highmark Wholecare Pharmacy Division Phone 800-392-1147 Fax 888-245-2049 Effective 1/8/2024 iii. A diagnosis of other severe hypercholesterolemia (baseline [before treatment with any lipid-lowering agent] LDL-C ≥190 mg/dL), b. Has a history of one of the following: i. Failure to achieve goal LDL-C or percentage reduction of LDL-C while ...2024 Food and Utility Benefits. Every month, Highmark, Wholecare Diamond and Ruby members will receive a monthly allowance to help with Food and Utility expenses. Diamond plan members will receive $175 and Ruby members will receive $35 a month. The monthly amount can be used as needed at select food retailers or on select utilities.Care Programs. Additional services can be found in the Member Handbook. You can find Co-Payments in "Section - 2 Rights and Responsibilities." Highmark Wholecare offers Medicaid health insurance coverage for Pennsylvania residents. Learn about our Medicaid coverage plans and member benefits today.Join Highmark Wholecare to Learn More About Medicaid Redetermination . Dear Provider, The COVID-19 public health emergency (PHE) continuous coverage requirement ended on April 1, 2023. Because of this, Medical Assistance (MA) health care coverage may expire for certain MA recipients if they are no longer eligible following their annual renewal.We send our Medicare Advantage members a Personalized Wellness Plan 3 times a year with a list of activities, tailored to each member’s health & well-being.You may also complete the enrollment form, sign and date it, and mail or fax the enrollment copy to: Highmark Wholecare. Attn: Enrollment 444 Liberty Avenue, Suite 2100 Pittsburgh, PA 15222 Fax: 1-888-551-9101 (toll-free) Highmark Wholecare ofers HMO plans with a Medicare contract. Enrollment in these plans depends on contract renewal.Highmark launched the Predictal Auth Automation Hub utilization management tool that allows offices to submit, update, and inquire on authorization requests. ... We also have resources available for Physical Medicine Management authorizations, which transitioned to Highmark managed in December 2023.Highmark Wholecare. Attn: Enrollment. 444 Liberty Avenue, Suite 2100 Pittsburgh, PA 15222 Fax: 1-888-551-9101 (toll-free) Highmark Wholecare Highmark Wholecare . Medicare Assured Diamond. SM. edicare Assured Ruby M. SM. Highmark Wholecare offers HMO plans with a Medicare contract. Enrollment in these plans depends on . contract renewal.Highmark Wholecare’s Diamond plan members have access to a monthly amount of money to buy hundreds of healthy food items, including fresh produce. Every month, Diamond members will receive $135 which can be used to buy foods at select retailers, online or by the phone.Organization grows with the addition of Highmark Western and Northeastern New York and Highmark Wholecare, formerly Gateway Health; Highmark Health Year-End 2021 Financials. PITTSBURGH (March 22, 2022) — Highmark Health today announced financial results for year-end 2021, reporting $22 billion in consolidated revenue, an operating gain of ...Highmark Blue Cross Blue Shield or Highmark Blue Shield are Medicare Advantage HMO, PPO, and/or Part D plans with a Medicare contract. Enrollment in these plans depends on contract renewal. Benefits and/or benefit administration may be provided by or through the following entities, which are independent licensees of the Blue Cross Blue Shield ...Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) is a Medicare Advantage (Part C) Special Needs Plan by Highmark Wholecare Medicare Assured. Premium: $0.00 Enroll Now This page features plan details for 2024 Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) H5932 – 001 – 0 available in SW NW NE Central …Pittsburgh, PA 15253-5191. Send us a request by fax to: All Providers 1-844-207-0334. Clinical Provider Appeals: Highmark Wholecare. Attention: Provider Appeals Department. P.O. Box 22278. Pittsburgh, PA 15222. Send us a request by fax to: Non-Participating Medicare Provider, and any Pre-Service Appeals: 412-255-4503.2. Highmark Wholecare's Fraud Prevention and Detection Plan hereby provides that in accordance with Highmark Wholecare's Pennsylvania Medicaid contract and the Centers for Medicare and Medicare (CMS) guidance, Highmark Wholecare's Fraud, Waste and Abuse Team establishes procedures for the investigation of referrals of suspicious or fraudulentIf you already have a doctor (primary care physician or "PCP") in mind, please call Member Services at 1-800-392-1147 TTY 711 to make your doctor selection. If you do not have a PCP, please call Member Services at 1-800-392-1147 TTY 711 and a representative will help you find a doctor that accepts Highmark Wholecare.Download and mail completed forms to: Highmark Wholecare. Attention: Medicare Enrollment Department. P.O. Box 535191. Pittsburgh, PA 15253-5191. Health benefits or health benefit administration may be provided by or through Highmark Wholecare, an independent licensee of the Blue Cross Blue Shield Association …Highmark Wholecare is pleased to announce several exciting benefit enhancements for Medicare plan members beginning January 2024. 2024 Highmark Wholecare Benefits Healthy Foods and Utility Support Benefit: Diamond Members - $175 per month can be used toward plan-approved utility ... 9/25/2023 9:52:51 AM ...Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) is a Medicare Advantage (Part C) Special Needs Plan by Highmark Wholecare Medicare Assured. Premium: $38.80. Enroll Now. This page features plan details for 2024 Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) H5932 - 013 - 0 available in SE Pennsylvania Counties.You deserve a reward. Healthy Rewards is one of your Highmark Health Options benefits. You or your child can earn rewards when you complete certain healthy activities. SIGN UP ONLINE. Or call 1-866-469-7973.These drugs should be used by doctors and pharmacists when they are a good fit. View the latest Formulary Changes Learn how to search the Drug List. 90 Day Medication Supply. Highmark Wholecare offers a 90-day supply of select generic medications for diabetes, asthma, cholesterol, blood pressure, mental health and more.Provider Manual. The provider manual is reviewed in detail by a provider relations representative with the provider within 30 calendar days of the provider successfully gaining approval to participate in the Highmark Wholecare network. The provider manual includes information regarding EPSDT requirements such as Blood Lead Screening, Vaccines ...Provider Directory. Site Map. Legal Information. 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 ...Current as of: 5/1/2023. Please be aware that Highmark Wholecare Medicare Assured may need to change its current list of approved drugs (drug formulary) from time to time. Highmark Wholecare may add, revise or remove a drug, move a drug to a different cost-sharing tier, add specific rules for use, place quantity limits, require prior drug ...2023 Highmark Wholecare Benefits Highmark Wholecare Medicare Assured Ruby (HMO SNP) Highmark Wholecare Medicare Assured Diamond (HMO SNP) Premiums and Benefits Monthly Plan Premium You pay $0. You pay $0. Deductible No deductible. No deductible. You pay no more than $6,700 annually for in-network Medicare-covered …This information is issued on behalf of Highmark Wholecare, which is an independent licensee of the Blue Cross Blue Shield Association. 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.If you are unsure of which formulary your group uses, please consult your plan’s administrator. If you would like a paper copy of your Formulary, we will gladly mail it to you. Call us at 1-866-677-8565 (TTY users call 711) so that we can help. Representatives are available 8 a.m. - 8 p.m., seven days a week.Highmark Wholecare Medicare Plan Benefits. NEW Healthy Food Benefit: Up for $1,620 an year for groceries NOVEL Utility Support Benefit: Up to $400 a annual 100 FREE Horse: NOW including trips to the gym with grocery store NEW: Pay $0 for all prescription drugsProviders will continue to have the ability to access and receive electronic remittances through ECHO Health by: Downloading Electronic Remittance Advices (ERAs) directly from the ECHO Health provider web portal to bypass dependency on a clearinghouse. Downloading a human-readable remittance (PDF format) for manual posting of cash receipts.Highmark Blue Shield is a Medicare Advantage HMO, PPO, and/or Part D plan with a Medicare contract. Enrollment in these plans depends on contract renewal. Benefits and/or benefit administration may be provided by or through the following entities which are independent licensees of the Blue Cross Blue Shield Association: Highmark Inc. d/b/a …Three summer mobile dental tours will crisscross Pennsylvania caring for more than 1,000 children, young adults and senior Pennsylvanians. PITTSBURGH (June 12, 2023) — Highmark Inc. and Highmark Wholecare are major sponsors of United Concordia Dental's mobile dental tours providing free onsite dental services — including exams, cleanings and fluoride treatments — to underserved ...The Highmark Wholecare Medicare Assured Part B diabetes monitoring device and supply policy. Diabetes devices and supplies obtained from a Durable Medical Equipment (DME) provider are not limited to certain manufacturers. However, when these products are obtained from a pharmacy, specifed manufacturers are limited. Highmark WholecareHealth benefits or health benefit administration may be provided by or through Highmark Wholecare, an independent licensee of the Blue Cross Blue Shield Association (“Highmark Wholecare”). Highmark Wholecare offers HMO plans with a Medicare Contract. Enrollment in these plans depends on contract renewal. Medicare Ombudsman Website Best ......