Provider Resource Center

[{"id":392,"versionId":5,"title":"UM Transitions","type":4,"subType":null,"childSubType":"","date":"3/26/2024","endDate":null,"additionalDate":null,"imageUrl":null,"url":null,"baseUrl":null,"urlText":null,"description":"\u003cp\u003e\u003cstrong\u003eImportant UM Authorization Updates:\u003c/strong\u003e Starting May 1st, there will be updates to the authorization requirements and processes for various Highmark Wholecare services. To learn more about these specific changes and to review reference materials, visit the following links:\u003cstrong\u003e \u003cu\u003e\u003ca href=\"https://wholecare.highmarkprc.com/Provider-Newsletters/Wholecare-Newsfeed/391/New-Authorization-Requirements-for-Musculoskeletal-Pain-Management-Diagnostic-Imaging-and-Physical-Medicine\"\u003eMusculoskeletal/Pain Management, Diagnostic Imaging and Physical Medicine\u003c/a\u003e,\u003c/u\u003e\u003c/strong\u003e\u0026nbsp;\u003cstrong\u003e\u003cu\u003e\u003ca href=\"https://wholecare.highmarkprc.com/Provider-Newsletters/Wholecare-Newsfeed/390/New-Authorization-Process-for-Family-Planning\"\u003eFamily Planning\u003c/a\u003e,\u003c/u\u003e\u0026nbsp;\u003cu\u003e\u003ca href=\"https://wholecare.highmarkprc.com/Provider-Newsletters/Wholecare-Newsfeed/389/New-Authorization-Requirements-for-Cardiology\"\u003eCardiology\u003c/a\u003e\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e","longDescription":null,"visible":false,"archive":false,"liveStatus":2},{"id":393,"versionId":5,"title":"UM Fax Number Update","type":4,"subType":null,"childSubType":"","date":"3/26/2024","endDate":null,"additionalDate":null,"imageUrl":null,"url":null,"baseUrl":null,"urlText":null,"description":"\u003cp style=\"margin: 0in;\"\u003eHighmark Wholecare has made updates to the Utilization Management (UM) fax numbers to help better service provider requests. The new fax numbers are specific to various Highmark Wholecare Medicare and Medicaid services and can be found \u003cu\u003e\u003ca href=\"https://wholecare.highmarkprc.com/Provider-Newsletters/Wholecare-Newsfeed/378/UM-Fax-Number-Changes\"\u003e\u003cb\u003ehere\u003c/b\u003e\u003c/a\u003e\u003c/u\u003e\u003cb\u003e. \u003c/b\u003eThese new fax numbers are now live and should be used going forward. \u003co:p\u003e\u003c/o:p\u003e\u003c/p\u003e","longDescription":null,"visible":false,"archive":false,"liveStatus":2},{"id":383,"versionId":5,"title":"Change Healthcare Cyber Incident Banner","type":4,"subType":null,"childSubType":"","date":"3/19/2024","endDate":null,"additionalDate":null,"imageUrl":null,"url":null,"baseUrl":null,"urlText":null,"description":"\u003cp\u003eImportant Provider Notice - March 5, 2024 - Change Healthcare Event: Highmark Wholecare Claims/Remittance Update\u0026nbsp;-\u0026nbsp;\u003ca href=\"https://content.highmarkprc.com/Files/Wholecare/Forms/BS_Wholecare%20Provider%20Notification%20Change%20Healthcare%20Update%20FINAL%203.5.24%20245pm.pdf\"\u003ePlease click here for more information.\u003c/a\u003e\u0026nbsp;Additionally, to learn more about how Highmark Wholecare is assisting providers impacted by the Change Healthcare cyber event, click \u003ca href=\"https://wholecare.highmarkprc.com/Provider-Newsletters/Wholecare-Newsfeed/382/Assistance-for-Highmark-Wholecare-Participating-Providers-Impacted-by-Change-Healthcare-Cyber-Event\"\u003ehere.\u003c/a\u003e\u003c/p\u003e","longDescription":null,"visible":false,"archive":false,"liveStatus":2},{"id":289,"versionId":5,"title":"E-Subscribe Provider Website Banner","type":4,"subType":null,"childSubType":"","date":"12/6/2023","endDate":null,"additionalDate":null,"imageUrl":null,"url":null,"baseUrl":null,"urlText":null,"description":"\u003cp\u003eThe Highmark Wholecare Provider Newsletter has been replaced with the \u003cstrong\u003e\u003cem\u003eProvider News\u003c/em\u003e monthly email\u003c/strong\u003e. The \u003cem\u003eProvider News\u003c/em\u003e email will become our primary communications channel, allowing us to consolidate and simplify updates for you each month. \u003ca href=\"https://wholecare.highmarkprc.com/e-Subscribe-for-Publications-and-Notifications\"\u003eSubscribe here\u003c/a\u003e to stay up-to-date with Highmark Wholecare member programs, provider policies, claims, reimbursement, and more!\u003c/p\u003e","longDescription":null,"visible":false,"archive":false,"liveStatus":2},{"id":287,"versionId":5,"title":"GuidingCare Provider Website Banner","type":4,"subType":null,"childSubType":"","date":"11/30/2023","endDate":null,"additionalDate":null,"imageUrl":null,"url":null,"baseUrl":null,"urlText":null,"description":"\u003cp style=\"margin: 0in;\"\u003eProviders now have access to a new Clinical Platform, GuidingCare. This platform allows access to an Authorization Portal via NaviNet. Please utilize this online capability as the preferred method to submit your authorization requests. To learn more about accessing this new platform, please review the provider guide \u003ca href=\"https://content.highmarkprc.com/Files/Wholecare/docs/GuidingCareUserGuide.pdf\"\u003ehere\u003c/a\u003e.\u003co:p\u003e\u003c/o:p\u003e\u003c/p\u003e","longDescription":null,"visible":false,"archive":false,"liveStatus":2}]

In December 2016, the 21st Century Cures Act was enacted into law by the 114th United States Congress. Section 212006 of the Cures Act requires all states to implement the use of Electronic Visit Verification (EVV) for Medicaid-funded personal care and home health services that require an in-home and community visit. EVV is a technology solution that electronically verifies the utilization and delivery of care services.

On January 1, 2021, Highmark Wholecare (formerly Gateway Health) implemented Netsmart EVV to electronically verify the utilization and delivery of care services for its Medicaid members.

How does Netsmart EVV work?

Netsmart EVV solution is an easy-to-use, web and mobile-based solution. It will provide you with a comprehensive set of tools to easily manage your visit schedules, care plans and claims processing. Using mobile technology, Netsmart captures the time and location that those services are delivered — ensuring your patients receive the medically necessary services and support they need. With EVV, you can easily schedule, monitor and verify visits as well as submit timely and accurate claims for processing.

Dear Provider Admin

Netsmart and Highmark Wholecare (formerly known as Gateway Health LLC) enhanced the Missed Visit Workflow.

Below you will find the User Guide for the Missed Visits enhancement for reference. This functionality was enabled August 17, 2022. Utilizing the Missed Visit reason will be required for all visits missed on or after October 31, 2022.
As a reminder, your agency’s Caregivers now have the ability to select a missed visit reason and a missed visit action taken within the mobile application. Caregivers will have the ability to enter free text regarding the missed visit. If the Caregiver does not select this information, then the Provider Admin will be required to update the missed visit status.
If you are using a third party vendor, you need to reach out to your vendor to ensure they are aware of the changes if you have not already done so. Netsmart communicated the technical specs to any current integrated vendor with Netsmart for Highmark Wholecare.

Click here to view the Missed Visits Recording.
Click here to view the Provider Portal User Guide for Missed Visits.
Click here to view the Mobile App User Guide for Missed Visits.

Thank you for your continued partnership and attention to this matter,
The Netsmart Team

Highmark Wholecare Resources:

Medicaid Provider Updates
EVV for Home Health Care Services (HHCS) - September 13, 2023 Townhall - ZOOM Presentation
EVV for Home Health Care Services (HHCS) - September 13, 2023 Townhall - PDF
EVV for Home Health Care Services (HHCS) - July 20, 2023 Townhall - ZOOM Presentation
EVV for Home Health Care Services (HHCS) - July 20, 2023 Townhall - PDF
EVV Home Health Care Services (HHCS) Implementation
- YouTube Video
Town Hall EVV Launch for Home Health Care Services
- YouTube Video

Additional Resources:

Last updated on 3/25/2024 2:15:44 PM

Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration.

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How does Netsmart EVV work?

Dear Provider Admin

Highmark Wholecare Resources:

Additional Resources:

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