What is the payer ID for Highmark Wholecare?

The payer ID for Highmark Wholecare is 96938.

How long does Highmark Wholecare provider enrollment take?

Highmark Wholecare provider enrollment typically takes 60-90 days from application to effective date. Timelines vary by state, plan, and how complete the application is.

Does Highmark Wholecare require CAQH?

Yes. Highmark Wholecare uses CAQH for credentialing data, so keep the provider's CAQH profile current and attested before applying.

Does Highmark Wholecare require ERA enrollment?

Yes. Highmark Wholecare requires a separate ERA (835) enrollment before electronic remittances flow, and setup typically takes several weeks.

What states does Highmark Wholecare cover?

Highmark Wholecare operates in PA. Coverage can differ by plan and product line, so confirm the specific plan before you file.

Highmark Wholecare

Part of Gateway Health Plan

Medicaid managed caredental

Typical enrollment turnaround

60-90 days

Summary

Highmark Wholecare is a Medicaid managed care organization, part of Gateway Health Plan, offering dental coverage operating in Pennsylvania. Claims route under payer ID 96938. Provider enrollment typically takes 60-90 days, with applications through Gateway Provider Portal, and CAQH is used for credentialing data. Through clearinghouses it supports eligibility checks, dental claims, and electronic remittance (ERA); ERA enrollment is required and takes several weeks.

At a glance

Payer ID: 96938
Also known as: Gateway Health Plan Dental, Scion Gateway Health Plan, Skygen USA
Uses CAQH: YesApplication route: Payer portal application
Service area: PA

Clearinghouse transaction setup

Which EDI transactions this payer supports, and how long clearinghouse enrollment typically takes when it is required.

Transaction	Enrollment	Typical setup
Eligibility checks (270/271)	Not required	Immediate
Dental claims (837D)	Not required	Immediate
ERA / remittance (835)	Required	Several weeks

Common questions

What is the payer ID for Highmark Wholecare?: The payer ID for Highmark Wholecare is 96938.
How long does Highmark Wholecare provider enrollment take?: Highmark Wholecare provider enrollment typically takes 60-90 days from application to effective date. Timelines vary by state, plan, and how complete the application is.
Does Highmark Wholecare require CAQH?: Yes. Highmark Wholecare uses CAQH for credentialing data, so keep the provider's CAQH profile current and attested before applying.
Does Highmark Wholecare require ERA enrollment?: Yes. Highmark Wholecare requires a separate ERA (835) enrollment before electronic remittances flow, and setup typically takes several weeks.
What states does Highmark Wholecare cover?: Highmark Wholecare operates in PA. Coverage can differ by plan and product line, so confirm the specific plan before you file.

Compiled from public payer resources and clearinghouse catalogs. Details change often, so confirm with the payer before relying on them. Spot something out of date? Tell us and we will fix it.