Highmark Wholecare

Summary

Highmark Wholecare is a Medicaid managed care organization, part of Gateway Health Plan, offering medical coverage operating in Pennsylvania. Claims route under payer ID 10629T, with 5 alternate IDs in use across clearinghouses. 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, claim status inquiries, professional claims, institutional claims, and electronic remittance (ERA); ERA enrollment is required and takes several weeks.

At a glance

Payer ID

10629TAlso seen as 25169, 4569, 8472, GATHP, GHPMCD

Also known as

Gateway Health Plan Medicaid Pennsylvania

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.

Common questions

What is the payer ID for Highmark Wholecare?

The payer ID for Highmark Wholecare is 10629T. Alternate IDs seen across clearinghouses include 25169, 4569, 8472, GATHP.

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.

Related payers