Join Our Network

Thanks for your interest in becoming a Highmark Wholecare network provider. Your request will be reviewed and you will be contacted by phone and/or email within the next 12 business days.

Before completing the application please review the below FAQs.

Required Key Information – Review prior to completing Application.
Key Information

Behavioral Health/Substance Abuse, Dental & Vision Care Providers

Behavioral Health, Substance Abuse, Dental and Vision

Provider Add and Change Forms

Cultural Competency
Cultural Competency Data Form

Additional Resources:

Are you currently participating with Highmark Wholecare? * Yes No

Which Line(s)-of-Business are you interested in applying for? * Medicaid Medicare Both

Do you currently accept PA Medicaid? * Yes No Per our HealthChoices Must be enrolled in the PA MA program and possess an active MMIS Provider ID.

Do you currently accept Medicare? * Yes No

Legal Entity Name:* Practice Name*: Primary Group NPI*: Primary Street Address: City:* State* Zip Code:* County:* Specialty*

Sub-specialties:*

Do you treat pediatric patients?* Yes No

Is your practice a Federally Qualified Heath Center (FQHC) or Rural Health Clinic (RHC)? * Yes No

Hospital Affiliation:

Are you Board Certified? * Yes No

Contact Person:* Title: Email Address:* Phone Number:* Fax Number:* Contact’s Address, City, State & Zip:* Please provide any additional information relevant to this request (i.e. supplemental information, special services offered, etc.):

This information is issued on behalf of Highmark Wholecare, coverage by Gateway Health Plan, 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. Highmark Wholecare serves Medicare Dual Special Needs plans (D-SNP) to Blue Shield members in 14 counties in northeastern Pennsylvania, 12 counties in central Pennsylvania, 5 counties in southeastern Pennsylvania, and to Blue Cross Blue Shield members in 27 counties in western Pennsylvania.