Updated September 1, 2026
Verify Highmark Wholecare eligibility in real time.
Highmark Wholecare supports electronic real-time eligibility. Send the check to payer ID 96938 and the full benefits picture comes back in seconds, before the patient sits down.
Also billed as: Gateway Health Plan Dental · Scion Gateway Health Plan · Skygen USA
Seconds
The same Highmark Wholecare check that takes 15 to 25 minutes on the phone. Ten patients tomorrow: ten checks, or three hours on hold.
4 billing names
Highmark Wholecare shows up on cards under 4 names. Every one routes to payer ID 96938. No guessing which card this is.
9 Highmark plans
verify in real time through Valian. One setup covers the whole Highmark family, Highmark Wholecare included.
From $39/mo
Per location, billed yearly. Found checks are billed once a month, $2.50 each and less as you run more. No seat fees, no processing fees.
The phone way
Call, hold, transcribe, repeat.
Verifying Highmark Wholecare by phone means a menu, a hold queue, and 15 to 25 minutes per patient while someone at the desk reads benefits back by hand. Ten patients on tomorrow's schedule is half a workday on hold.
The real-time way
Payer ID 96938, in seconds.
The same check, sent electronically. Sign in and run it for any patient in one click, and Valian flags the ones that need a human look.
| By phone | In Valian | |
|---|---|---|
| Time per patient | 15 to 25 minutes on hold | Seconds |
| When it happens | Day of, squeezed between patients | Any time before the visit, in one click |
| What you get | Notes scribbled while someone reads benefits aloud | The full breakdown, saved to the patient |
What a Highmark Wholecare eligibility check returns
- Whether coverage is active, with plan and group details
- Deductible, and how much of it is already met this year
- Annual maximum, and how much of it is left to work with
- Coverage percentages by category: preventive, basic, major
- Frequency limits on cleanings, exams, and X-rays
- Waiting periods, where Highmark Wholecare reports them electronically
Eligibility result
Sample data- Status
- Active
- Plan
- PPO · Group 8823
- Deductible
- $50 · $0 met
- Annual max
- $1,500 remaining
- Preventive
- 100%
- Basic
- 80%
- Major
- 50%
- Cleanings
- 2 / year
Returned in seconds · payer ID 96938
How practices handle this today, in their own words
Verbatim from recorded calls to dental offices. Names withheld.
We call the insurance, or I go on their website and do it. Yeah, we manually do it.
We have a third party insurance verification team that does it for us. I’m not too sure, maybe like seven, ten minutes.
Our system does it, and the ones that are not set up for electronic, we do ourselves.
How getting set up works
Book a discovery call
A 15-minute call with our team: we show you a check and size your plan. Then you sign up from the link we send you: create the account, sign the agreement, and put a card on file.
Save your carriers and codes
Pick the insurance carriers you take and the codes you check.
Run a check in one click
Sign in, pick a patient and see their coverage in seconds before the visit, Highmark Wholecare included. No hold music, no portal logins.
Under half an hour of your time all in. See how the software compares, how a real-time check works, or what outsourcing costs.
What Highmark Wholecare supports through our network
- Real-time eligibility (270/271)
- Yes, in seconds
- Enrollment for eligibility
- None, checks work day one
- Dental claims (837D)
- Yes
- Claim status (276/277)
- Not through our network
- Electronic remittance (835)
- Yes, after a one-click enrollment, typically over four weeks
- Electronic funds transfer
- Not through our network
- Claim attachments
- Not through our network
Names and IDs this payer goes by
Highmark Wholecare · Gateway Health Plan Dental · Scion Gateway Health Plan · Skygen USA. All of them route to payer ID 96938.
Payer site: www.highmark.com
How to verify Highmark Wholecare, step by step
Get the member ID and date of birth from the card or the patient.
Send the electronic eligibility request (a 270) to payer ID 96938.
Read the response (the 271): status, deductible, max, percentages, frequencies.
Save the breakdown to the patient. With Valian, all four take one click and a few seconds.
Highmark Wholecare runs Medicaid plans across Pennsylvania. Medicaid dental benefits change by state and by age, which is exactly what the check reads off the plan.
Highmark Wholecare, for your front desk
Phone numbers, from Highmark Wholecare's own provider pages.
- Provider customer service
- 800-392-1147
Source: Highmark Wholecare, contact us page. Checked September 19, 2026.
Highmark Wholecare, quick answers
Does Highmark Wholecare support real-time eligibility?
Yes. Eligibility checks to Highmark Wholecare clear electronically in seconds through payer ID 96938.
What payer ID do I use for Highmark Wholecare?
96938 for eligibility transactions. The same payer also appears on cards as Gateway Health Plan Dental, Scion Gateway Health Plan, Skygen USA.
What does a check cost with Valian?
Plans from $39 a month per location, billed yearly, or from $49 month to month. Plus $2.50 or less per check we find — $0 when we can’t find the insurance. No setup fee and no seat fees. Sign in and run each check in one click before the visit.
Does Highmark Wholecare require enrollment before I can check eligibility?
No. Eligibility checks work from day one, with no payer enrollment paperwork.
Which Highmark Wholecare plans does this cover?
Highmark Wholecare runs Medicaid plans in Pennsylvania. The eligibility check reads the specific plan on the patient's card, whichever program it belongs to.
Can I get Highmark Wholecare remittances electronically?
Yes. Highmark Wholecare sends electronic remittance advice (835) after a one-click enrollment, typically over four weeks.
What if the patient's card shows a different Highmark name?
Alternate billing names route to the same payer ID, 96938. The same check covers them.
More questions about verifying Highmark Wholecare? Schedule 15 minutes with us and bring your toughest plan.
Check any Highmark Wholecare patient in one click, before they walk in.
Plans from $39 a month per location, billed yearly, or from $49 month to month. Plus $2.50 or less per check we find — $0 when we can’t find the insurance. No setup fee and no seat fees.
Book 15 minutes, demo or onboarding
Pick a time, then tell us on the form whether it is a demo or an onboarding call.
Other Pennsylvania dental payers
32 other payers operating in Pennsylvania also verify in real time, 10 of them with Medicaid plans.
- Aetna Better Health Pennsylvania23228
- AmeriHealth95044
- AmeriHealth Caritas Northeast77001
- AmeriHealth Caritas Pennsylvania22248
- Blue Shield of PennsylvaniaCB865
- Blue Shield of Pennsylvania - Dental PlusCBPA2
- CareFirst Blue Cross Blue Shield MarylandSB690
- CareFirst Blue Cross Blue Shield Maryland - Dental00580
- Central Pennsylvania Teamsters Health & Welfare FundTLU51
Medicaid plans in Pennsylvania: Aetna Better Health Pennsylvania, AmeriHealth Caritas Northeast, AmeriHealth Caritas Pennsylvania, CareFirst Blue Cross Blue Shield Maryland, Geisinger Health Plan, Health Partners Plans, and 4 more.
The Highmark family in the network
9 Highmark plans verify in real time through Valian.
- Verify Highmark Blue Cross Blue Shield (NY) - Medicaid and CHP eligibility
- Verify Highmark Blue Cross Blue Shield (Western and Northeastern NY) eligibility
- Verify Highmark Blue Cross Blue Shield of Delaware eligibility
- Verify Highmark Blue Cross Blue Shield of Western New York eligibility
- Verify Highmark Blue Shield of Northeastern New York eligibility
- Verify Highmark Delaware Health Options eligibility
- Verify Highmark Health Options West Virginia eligibility
- Verify Highmark Wholecare Medicare Assured eligibility
Payer names and marks belong to their owners and identify the insurance company a practice can verify. Sample result shown for illustration; real results reflect the patient's actual plan. Payer capabilities can change between network updates.