Claims Billing Errors

Top Ten Claims Billing Errors For Highmark Healthcare Providers Top Ten Claims Billing Errors  have been identified to help providers send and process claims correctly. Incorrect provider number listed – Generally, the billing provider number is the assignment account, while the performing provider number is the individual practitioner. If practices are unsure which National Provider Identifier (NPI) to Read More →

HIPAA Billing

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

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 →

Benefits Of Electronic Claims

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

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

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 →

Highmark EDI Operations

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 →