HIPAA Billing Internal Dispute Process At Highmark HIPAA billing dispute regarding claims payment decisions made by Highmark can be requested by any provider that treats a Highmark member. Any claim dispute between a provider and Highmark arising from a provider’s request for payment is solely a contract dispute between the provider and Highmark, and does not involve … Read More →
HIPAA Claim Investigation (Highmark) HIPAA claim investigation is the ordinary means providers use to communicate their questions regarding pending, paid, or denied claims. An investigation should be submitted if the provider has a question about the status of a claim. Complete research should be completed by the provider prior to submitting the investigation. A claim investigation … Read More →
Emblem Health HIPAA Claims Electronic Submission Emblem Health HIPAA Claims are received from thousands of health care practitioners that eliminated paper claims and are submitting electronic claims in HIPAA-compliant professional provider (837P), institutional provider (837I) and dental provider (837D) EDI claims transaction formats. When billing electronically, please allow a reasonable amount of time to complete your account … Read More →
Remittance Advice Guidelines (Palmetto GBA Providers) Remittance Advice is sent to nonparticipating physicians, suppliers, and non-physician practitioners billing non-assigned claims, unless the beneficiary or the provider requests that the remittance advice be suppressed. An informational Remittance Advice is identical to other RAs, but must carry a standard message to notify providers that they do not have … Read More →