Highmark EDI Operations Provider Service

Highmark EDI OperationsHighmark 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 time when calling, be prepared to provide your Trading Partner number, NPI, and log-on identification to the support analyst.

Electronic transactions can be sent and retrieved seven days a week, 24 hours a day. Electronic transactions can be submitted once or multiple times per day or week. Claim transmittal and report retrieval schedules are controlled by each office. Information on EDI Claim Submission can be found on the EDI website by visiting the Electronic Data Interchange (EDI) Services website via the Provider Resource Center.

HIPAA electronic transactions

In 1979, the American National Standards Institute (ANSI) chartered the Accredited Standards Committee (ASC) X12 to develop and maintain uniform standards for Electronic Data Interchange (EDI). ASC X12N is the section of ASC X12 for the health insurance industry’s administrative transactions. Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Administrative Simplification provisions named ASC X12N as the mandated standard to be used for electronic transmission of health care transactions.

The current HIPAA electronic transaction standards for health care eligibility, claim status, referrals, claims, and remittances are the ASC X12N Version 5010 transactions. The required formats for electronic claim submission are:

  • Professional: ASC X12N 837 Health Care Claim: Professional Transaction Version 005010 (“837P”)
  • Institutional: ASC X12N837 Health Care Claim: Institutional Transaction Version 005010 (“837I”)

The following types of electronic claim submission are available to participating facilities:

  • Batch submission and Real-Time Estimation/Adjudication (limited to a single claim) via any electronic data interchange vendor
  • NaviNet® UB Claim Submission

Professional providers have the following options:

  • Submission via any electronic data interchange vendor or billing service
  • NaviNet® 1500 Claim Submission

The NaviNet claim submission transactions are compliant with the HIPAA 837P and 837I formats.

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