EmblemHealth Electronic Claims Submission Requirements EmblemHealth Electronic Claims should not be duplicated. When duplicate claims are submitted, vendor potentially delays claims processing and create confusion for the member. Attachments cannot be submitted electronically at this time. However, most claims should be submitted electronically. If supporting documentation is required for the settlement of a vendor claim, EmblemHealth will request it. Read More →

Electronic Remittance Advice And Electronic Funds Transfer for EmblemHealth Claims Electronic Remittance Advice and Electronic Funds Transfer are the standards for receiving EmblemHealth payments. Electronic Remittance Advice can be processed via PNC Remittance Advantage, a no-cost online payment solution that helps your office reduce payment processing expenses and improve cash flow. With PNC Remittance Advantage, you can receive Read More →

National Provider Identifier Requirements (EmblemHealth Electronic Claims Submission) National Provider Identifier (NPI) should be checked by vendor practice management system to ensure vendor software is capturing and correctly populating a National Provider Identifier (NPI) in electronic claims, otherwise claims will be rejected by EmblemHealth. Please note the following NPI requirements for electronic health care claim submissions: Professional Provider Read More →

Benefits Of Electronic Claims Submissions At (Highmark Billing & Payment) Benefits Of Electronic Claims – convenient, confidential, and operational around the clock. All it takes is 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 Read More →

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 →