Highmark Wholecare — Pennsylvania — Medicaid

Standard filing limit

90 days

Counted from

date of service

Appeal filing limit

Not stated

Appeal window from

Not stated

Notes

Highmark Wholecare (PA Medicaid): ensure claims are received within 90 days of the date of service to be considered timely (official provider newsletter).

Provider portal

https://providers.highmark.com/wholecare.html ↗ (opens in a new tab)Copy●Verified · August 2026Verified Aug 18, 2026 · Official web pageView source ↗ (opens in a new tab)

Highmark Wholecare Provider Resource Center — prior authorization tools, policy updates and claims.

Provider Services

800-392-1147Copy●Verified · August 2026Verified Aug 18, 2026 · Official web pageView source ↗ (opens in a new tab)

Highmark Wholecare Medicaid Member and Provider Services — claims, eligibility and benefits (official contact page; Mon–Fri 8 a.m.–8 p.m.).

Every contact is individually source-tracked and shows the date it was last verified. A green “Verified” badge only appears when a source and verification date exist.

Authorization

Not yet published for this entry. Prior authorization requirements, channels and retro-authorization rules are published only when verified against a source.

Referrals

Not yet published for this entry. Referral requirements and retro-referral rules are published only when verified against a source.

Appeals

Not yet published for this entry. Appeal levels, filing channels and external-review options are published only when verified against a source.

Documentation requirements

Not yet published for this entry. Required documentation for appeals and additional-information requests is published only when verified against a source.

Common CARCs

19729

Common RARCs

MA119N29

Top reasons

Precertification / prior authorization / notification absent (CARC 197) — the payer documents authorization requirements for covered services.; Timely filing (CARC 29) — this plan documents a 90-day claim-filing window from the date of service; claims filed after the window are denied for exceeding the time limit (paired RARC MA119: provider-level adjustment for late claim filing).