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This Annual Notice of Changes gives you a summary of changes in your benefits and costs for 2024. For details, look in the 2024 Evidence of Coverage for Community Blue Medicare PPO Distinct. The Evidence of Coverage is the legal, detailed description of your plan benefits. It explains your rights and the rules you need to follow to get covered ...You can also call Member Services at 1-800-392-1147 (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”). Highmark Wholecare offers HMO plans with a Medicare Contract.Your session is about to expire! Click the button below to extend your session and stay logged in. You will be logged out after 5 more minutes of inactivity.Highmark Coding Tips is a periodic article that contains billing and coding best practices for professional and facility providers. Please refer to the Reimbursement Policy page for specific code edits used in Highmark's claims processing system. This publication focuses only on correct coding guidelines and tips to avoid common billing mistakes. For all other …Highmark Wholecare Memorial Day Free 5K Gettysburg, PA City Location Adams County. May 29, 2023 - Monday. 5K run. Race Information Details from event's RunSignUp.com listing: FREE 5K! This is a chip timed event, completely free for all participants! ONLINE REGISTRATION CLOSES SUNDAY, MAY 28 AT 7:00 PM! ...By providing your email you will receive confirmation of your request as well as other helpful information from Highmark Wholecare. Get my kit. Need help? Give us a call at. 1-877-428-3929 (TTY 711) 7 days a week, 8 a.m. to 8 p.m.If you are a Highmark member, you can enjoy the benefits of ordering over-the-counter (OTC) products online from the Highmark OTC Store. You can browse the catalog, check your allowance, and place your order with free shipping. Visit the Highmark OTC Store today and get the products you need for your health and wellness.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.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 ...Some children will struggle more in some environments than others—and accepting that may be the best way to help them cope. It’s a cliché to say very child is different, but it’s u...Goodness Rewards Hearing Care Lifestyle Management Asthma Heart Disease ... 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 ...January 1 - December 31, 2023 Evidence of Coverage: Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Complete Blue PPO Distinct (PPO) This document gives you the details about your Medicare health care and prescription drug coverage from January 1 - December 31, 2023. This is an important legal document.Rewards can add up. You’ll get a Healthy Rewards card in the mail. You can use your card like a credit card at most retail stores. Get the TheraPay Rewards app to make it easy. See what activities and rewards you qualify for. And watch your rewards add up. To participate by phone, call TheraPay at 866-469-7973 and talk to a Healthy Rewards ...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 27 counties in western ...5/1/2023 Zosyn IV Solution 3-0.375gm Formulary Deletion Generic Available Piperacillin Sod - Tazobactam Sod Sol 3.375 (3-0.375) GM IV Tier 3 Please be aware that Highmark Wholecare Medicare Assured may need to change its current list of approved drugs (drug formulary) from time to time.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. Save money on co-pays and make less trips to the pharmacy! View the complete list of medications covered for 90 days picture_as_pdf .Gastric Surgery/Therapy/Durable Medical Equipment/Outpatient Procedures: 888-236-6321. Home Health/Home Infusion Therapy/Hospice: 888-567-5703. Inpatient Clinical: 800-416-9195. Medical Injectable Drugs: 833-581-1861. Musculoskeletal (eviCore): 800-540-2406. Telephone: For inquiries that cannot be handled via the online provider portal, call ...Help Your Patients Enroll in Goodness Rewards! Call 1-833-559-2858 (TTY 711) Monday through Friday 7 a.m. - 7 p.m. EST and let us know that they would like to enroll in the program. The 2024 Medicaid Goodness Rewards Program. With the Goodness Rewards Program, members can earn a reward each time they complete an eligible health activity.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”).Highmark Blue Cross Blue Shield serves the 29 counties of Western Pennsylvania. Highmark Blue Shield serves the 21 counties of Central Pennsylvania and the Lehigh Valley as a full-service health plan. It also provides services in conjunction with Blue Cross of Northeastern Pennsylvania in Northeastern Pennsylvania and Independence Blue …Y0097_1359_2023_D. Customer Service 1-800-392-1147 TTY711 Member Portal Download on the App Store ... 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 ...Short-Acting Opioid Prior Authorization Form. Specialty Drug Request Form. Sunosi Prior Authorization Form. Testosterone Product Prior Authorization Form. Transplant Rejection Prophylaxis Medications. Vyleesi Prior Authorization Form. Weight Loss Medications Request Form. Last updated on 1/23/2024 5:32:02 PM. Contact Us.Call the Goodness Rewards helpline at. 1-833-559-2858 (TTY 711), Monday – Friday, 7 a.m. to 7 p.m. Is this program di erent from my Over-the-Counter (OTC) benefi t? Yes, the OTC Network is separate from the OTC benefi t received as a member of Highmark Wholecare.For 2023, Highmark’s Preventive Health Guidelines feature these changes: Nutritional counseling for Obesity Prevention in midlife women, ages 40 to 60 years old, with normal body mass index (BMI) and overweight BMI. Explanation: Women’s Preventive Services Initiative recommends counseling midlife women with normal or overweight BMI (18.5-29 ...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. …Highmark Wholecare covers family planning services. These services include: Pregnancy testing. Testing and treatment of sexually transmitted diseases. Birth control supplies, including up to a 12-month supply of oral contraceptives. Family planning education and counseling. In April 2014, the Office of Population Affairs (OPA) and the Centers ...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 utilityBeginning July 1, 2023, the ID numbers for Highmark Wholecare Medicaid and Medicare members will begin with a three-character prefix. The eight-digit numeric portion of the member ID will not be changing. As a result of these changes all Highmark Wholecare Medicaid and Medicare members will receive a new Highmark Wholecare ID card in July.Highmark Wholecare Medicare Assured Diamond SM Highmark Wholecare Medicare Assured Ruby SM Apply with this form, online or by phone. If you have any questions, we're here to help! highmarkwholecare.com 1-877-428-3929 (TTY 711) October 1 - March 31 8 a.m. to 8 p.m., 7 days a week April 1 - September 30 8 a.m. to 8 p.m., Monday - FridayProvider Webinar: 2023 Medicare Assured D-SNP Join Highmark Wholecare to learn about the NEW 2023 benefits and programs we are offering to our Medicare Assured Dual Eligible Special Needs Plan (D-SNP) members. This webinar will introduce the benefits and programs offered to assist members with their most basicBy providing your email you will receive confirmation of your request as well as other helpful information from Highmark Wholecare. Get my kit. Need help? Give us a call at. 1-877-428-3929 (TTY 711) 7 days a week, 8 a.m. to 8 p.m.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.How To File a Part C (Medical Services) Complaint or Appeal with Highmark Wholecare Grievances. A grievance is any complaint, other than one that involves a request for an organization determination expressing dissatisfaction with any aspect of the operations, activities or behavior of Highmark Wholecare or with the quality of care or service received from a Highmark Wholecare provider ...Please call 1-855-350-0074 (TTY 711) Monday - Saturday 8:00 AM to 5:00 PM; Sunday 10:00 AM to 5:00 PM. Please contact Highmark Wholecare member services at: 1-800-685-5209 8:00 AM to 8:00 PM, 7 days a week from 10/1 through 3/31. From 4/1 through 9/30 call between 8:00 AM to 8:00 PM Monday through Friday. Important Information: Ordering limits ...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.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 ...Welcome to 2024 Open Enrollment! Open Enrollment starts on November 1, 2023 and runs through January 19, 2024. If you enroll by December 15th, the plan will take effect on January 1, 2024. If you enroll after December 15th, your plan will take effect on February 1, 2024.By providing your email you will receive confirmation of your request as well as other helpful information from Highmark Wholecare. Get my kit. Need help? Give us a call at. 1-877-428-3929 (TTY 711) 7 days a week, 8 a.m. to 8 p.m.May 2023 . Medicaid Member Lab Requirements Changing June 1 . Beginning June 1, 2023, Highmark Wholecare Medicaid members will no longer be required to obtain laboratory services at a designated lab. Providers will be able to send their Highmark Wholecare Medicaid patients to any in-network lab with an order. Referrals are not required.Goodness Rewards Hearing Care Lifestyle Management ... Each Highmark Wholecare D-SNP offers its own benefit levels for dental care each year and some covered services …You can also call Member Services at 1-800-392-1147 (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"). Highmark Wholecare offers HMO plans with a Medicare Contract.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., Highmark Benefits Group Inc.,Our mailing address is: Highmark Fifth Avenue Place 120 Fifth Avenue Pittsburgh, PA 15222-3099 (412) 544-7000 (TTY/TDD: 711)...

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