Highmark Wholecare (formerly Gateway Health)
Also covers / subsidiaries: Gateway Health Plan, Gateway Health, Highmark Wholecare
Core Payer & Clearinghouse Profile
Electronic Payer ID
25169
25169 is listed for Gateway Health Plan d/b/a Highmark Wholecare. Legacy claims may still reference 'Gateway'. (Pennsylvania/West Virginia)
Timely Filing Limit (TFL)
365 days from the last DOS in PA and WV if not otherwise specified in your contract
Appeal Window
Varies — confirm via portal / clearinghouse
Clearinghouse Gateway
National Clearinghouse / EDI Gateway
Provider Services
855-501-3904
Claims Fax
844-207-0334
Claims Address
Highmark Wholecare, P.O. Box 535191, Pittsburgh, PA 15253-5191 (inquiries/reviews; verify submission box)
Provider Portal
https://providers.highmark.com/wholecare.html
Pennsylvania (and West Virginia) Medicaid/Medicare plan, formerly Gateway Health Plan — rebranded to Highmark Wholecare.
National EDI Clearinghouse Capabilities
Direct ANSI X12 electronic transaction support verified for Highmark Wholecare (formerly Gateway Health).
Resolution Tools for Highmark Wholecare (formerly Gateway Health) Claims
Values vary by plan, line of business, and provider agreement. Confirm in the payer portal or with your clearinghouse gateway before submitting electronic claims.
Tired of Chasing Highmark Wholecare (formerly Gateway Health) Denials & Delayed Payments?
Aethera's billing specialists work Highmark Wholecare (formerly Gateway Health) every day — handling EDI clearinghouse rejects, prior authorizations, payment posting, and 30-day AR aging recovery.