Highmark Wholecare (formerly Gateway Health)

Medicaid

Also covers: Gateway Health Plan, Gateway Health, Highmark Wholecare

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

Varies — confirm via portal / clearinghouse

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.

Values vary by plan, region, and contract and can change. Confirm in the payer portal or with your clearinghouse before filing.

Stop chasing Highmark Wholecare (formerly Gateway Health) denials and TFLs

Aethera's AR team works Highmark Wholecare (formerly Gateway Health) every day — payer rules, appeals, and clean-claim submission, handled.