Medicare Provider Updates



Provider Information Regarding COVID-19

Highmark Wholecare Providers can review updates regarding COVID-19. Click here to access the updates.

Medicare Provider Updates
Dec 2022 Notice of Medicare Policy Updates for Jan 1
Nov 2022 Important Update Regarding Maximum Out of Pocket (MOOP)
Nov 2022 Provider Notification for Post Service Authorization Requests
Nov 2022 Notice of Medicare Policy Updates for Dec 1
Oct 2022 Medications to Require Medical Prior Authorization, Effective Dec 1
Oct 2022 2023 NEW DSNP Member Benefits– Notice and Resource Guide
Oct 2022 2023 DSNP Member Benefits – Detail
Oct 2022 Provider Webinar: 2023 Medicare Assured D-SNP
Oct 2022 Medications to Require Medical Prior Authorization, Effective Nov 1
Oct 2022 Notice of Medicare Policy Updates for Nov 1
Sept 2022 Notice of Medicare Policy Updates for Oct 1
Aug 2022 Acute Migraine Treatment-GEPANTS Require Prior Authorization
Aug 2022 New Address For Paper Claims
July 2022 Notice of Medicare Policy Updates for Sept 1
July 2022 Notice of Medicare Policy Updates for Aug 1
July 2022 Authorization Requirements Medicare - Jul 1
June 2022 Provider Webinars: 2022 Annual Provider Education
June 2022 Shortage of Iodinated Contrast Agents
June 2022 Notice of Medicare Policy Updates for July 1
May 2022 NaviNet® and Enhanced Provider Portal Update
May 2022 ICD-10-CM Excludes Notes Training - June 3,2022
May 2022 Medications to Require Medical Prior Authorization, Effective July 1
May 2022 Prior authorization requirements for Sleep, Radiation Oncology and Cardiology began on April 1, 2022
May 2022 Notice of Medicare Policy Updates for June 1
Apr 2022 Upcoming Provider Webinars
Apr 2022 Payment Cycle Update
Apr 2022 Medicare Parts A and B Cost Sharing
Feb 2022 Medications to Require Medical Prior Authorization, Effective Apr 1
Feb 2022 Removal of Select Authorization Requirements for Medicare and Medicaid
Feb 2022 New Authorization Requirements for Sleep, Radiation Oncology and Cardiology - Revision
Jan 2022 Authorization Requirements Medicare - Jan 17
Jan 2022 Medications to Require Medical Prior Authorization, Effective Feb 21
Jan 2022 Navinet - Eligibility and Benefits Screen Update
Jan 2022 New Authorization Requirements for Sleep, Radiation Oncology and Cardiology
Jan 2022 Summary of 2022 Medicare Annual Formulary Change Notice


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.

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