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 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 →

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 →