Reportable Conditions

REPORTABLE CONDITIONS-Pennsylvania Code Regulations

Highmark Wholecare providers are contractually required to participate/adhere to Highmark Wholecare Quality Improvement (QI) Programs, including, but not limited to, complying with the regulations found in Title 28, Chapter 27, §27.21a “Reporting of cases by health care practitioners and health care facilities” of the Pennsylvania Code.

Providers are informed of these requirements through the agreement to participate, the Highmark Wholecare Provider Policy and Procedure Manual, Provider Newsletter, Highmark Wholecare website, and direct provider notices. The regulations which include the list of reportable conditions, can be found at the Pennsylvania Code website, www.pacode.com, or directly at http://www.pacode.com/secure/data/028/chapter27/s27.21a.html

Highmark Wholecare is required by the State to ensure providers are compliant to report any case of a qualifying disease, infection or condition within the required timeframe as specified in the PA Code.

*Action Required: Use this link to complete the attestation to acknowledge you have accessed, reviewed, understand, and are adhering to the State of Pennsylvania mandate to notify reportable conditions as detailed above.

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.