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 information for any member, whether claims were submitted electronically or on paper. You can track the status of a claim from the start of the adjudication process until the time of payment, or you can look up claims dating back seven years. To check claim status, select Claim Status Inquiry under Workflows for this Plan to access the Search screen and enter the patient and claim details.
276/277 — Health Care Claim Status Request and Response Transaction
The HIPAA-mandated 276/277 electronic claim status request and response are a paired transaction set — the 276 transaction is used by the provider to request the status of a claim(s) and the 277 transaction is used by the payer to respond with information regarding the specified claim(s). The response returned by the payer indicates where the claim is in the adjudication process (e.g., pending or finalized). If finalized, detailed information is provided on whether the claim is paid or denied, and if denied or rejected, the reason is included. Highmark will accept and return 276/277 transactions in Version 5010 format only. These transactions will only be accepted and returned via real-time; trading partners are not able to submit electronic inquiry transactions in a batch mode.
Information about the 276/277 transactions can be found in the EDI Guide, available on the Electronic Data Interchange (EDI) website. To access the website from the Provider Resource Center, select CLAIMS, PAYMENT & REIMBURSEMENT, and then Electronic Data Interchange (EDI) Services. Providers in all regions can contact Highmark EDI Services.