This section contains important billing and claims submission guidelines and other reference information to help you successfully conduct standard electronic transactions with Highmark.
Information about system maintenance and Electronic Data Interchange (EDI) changes can be found on our News page.
v5010 Provider Companion Guide
This document addresses how trading partners conduct professional claim, institutional claim, claim acknowledgment, , claim payment advice and real-time inquiries through HIPAA standard electronic transactions with Highmark in the 5010 version. This document supplements the HIPAA-mandated v5010 ASC X12 Implementation Guides and addenda with clarifications and payer-specific usage and content requirements.
Trading Partner Agreement: Providers
Trading partners who are professional or institutional providers will need to execute a Trading Partner Agreement with Highmark to conduct EDI business with Highmark.
Trading Partner Agreement: Clearinghouses and Vendors
Trading partners who are clearinghouses, billing services, or software vendors will need to execute a Trading Partner Agreement with Highmark to conduct EDI business with Highmark.
Secure Transport SFTP Specifications
This document addresses the Internet file transfer options available for Secure Transport, Highmark's secure file transfer protocol (SFTP) server. Trading partners must meet these technical requirements in order to connect to the Highmark Gateway.
v5010 ASC X12 Implementation Guides
This section provides a link to where trading partners may acquire the HIPAA-mandated v5010 ASC X12 Implementation Guides and their related standardized code lists.
This Supplemental Claim Information Cover Sheet is used when faxing or mailing supplemental information in support of an electronic claim. See the PWK instructions in the Attachments for Electronic Claims sections of the Provider Manual for additional usage information.