Claim Status Inquiry Guidelines (Highmark Healthcare Providers) Claim Status Inquiry (the status of a claim) can be checked by providers using NaviNet® Claim Status Inquiry or the 276/277 Health Care Claim Status Request and Response transactions. For non-routine inquiries that require analysis and/or research, contact Highmark’s Provider Services. Claim Status Inquiry lets you view real-time, detailed claims Read More →

Diagnosis Code Reporting And Reporting National Drug Codes Diagnosis Code Reporting subjects to the International Classification of Diseases (ICD) – a medical code set maintained by the World Health Organization (WHO). It was developed so that medical terms reported by physicians, medical examiners, and coroners can be grouped together for statistical purposes. Effective October 1, 2015, the Read More →

Timely Filing HIPAA Regulations At Highmark Timely filing is a Highmark requirement whereby a claim must be filed within a certain time period after the last date of service relating to such claim or the payment/denial of the primary payer, or it will be denied by Highmark. Any claims not submitted and received within the time Read More →

Highmark Clean Claim Guidelines For Providers Highmark Clean Claim is defined as a claim with no defect or impropriety and one that includes all the substantiating documentation required to process the claim in a timely manner. The core data required on a claim to make it clean are outlined in this section and the next Read More →

Highmark EDI Operations Provider Service Highmark EDI Operations support staff is comprised of trained personnel dedicated to supporting electronic communications. They provide information and assistance with questions or problems you encounter with any aspect of your EDI transactions. Support is free and staff is available Monday through Friday from 8 a.m. to 5 p.m. To save Read More →

Highmark Billing & Payment: Electronic Claim Submission Highmark Billing & Payment requirements cover a computer, the proper software, and an Internet connection for electronic claims submission. Instead of printing, bundling, and sending paper claims through the mail, simply enter and store claims data through your office computer. Electronic claims are convenient, confidential, and operational around the Read More →

How To Choose A Medical Billing Software Vendor For Submitting HIPAA Claims To Manitoba Health? Prior to selecting a medical billing software vendor the list of questions should be considered including requirements for the MHHLS billing applications. Installation: What is the waiting period for delivery and installation? Training: Is the training included in the purchase price? How Read More →

Claims Submission Procedures (First Time Submission Guidelines) Claims Submission procedures should be followed once vendor has met Manitoba Health requirements using a new Electronic User Site Number. At this time, Manitoba Health will review any areas of concern that were noted during the testing process and address vendor questions relating to handling reduced, rejected and returned claims. Any additional practitioners that join Read More →

HIPAA EDI Tests Guidelines for Providers (Part 2) HIPAA EDI Tests will be reviewed by MHHLS staff to determine areas where MHHLS requirements are met and areas where further testing is required. Practitioners may use fictitious patient demographics on test submissions. Some practitioner’s software programs will not allow fictitious patient data to be populated in thepractice management Read More →