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 →

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 →