Sign Up as a Trading Partner

What is a trading partner?

Any entity that conducts EDI transactions directly with the Highmark gateway is called an EDI “trading partner”. 

Do I need to sign up as a trading partner?

Whether you register as a trading partner depends on how you intend to do business with Highmark New York.

  • Do not register for your own trading partner ID if you are using a third-party intermediary who is already registered as a trading partner. However, note that a Provider Changes form must be submitted to affiliate an existing trading partner with any billing group NPI for which it conducts business.
  • Register to be a trading partner if you are not using a third-party intermediary or if your vendor does not maintain its own trading partner relationship. Please review the information below to get started.

What does the process involve?

You must complete the following steps before conducting EDI transactions as a trading partner:

  1. Successfully complete the online New Trading Partner Application ("Application") to receive your trading partner credentials. This allows you to connect to the Highmark gateway to send and receive EDI transactions.
  2. After you receive your credentials, affiliate the billing group NPIs for your existing provider clients to your trading partner profile. This enables EDI transactions for each of your clients.

Gathering trading partner information and provider data

Prior to beginning the Application, trading partners should be prepared with the following pieces of information:

  • Trading partner demographic information, including Tax ID Number.
  • Contact information for the trading partner team members identified above.
  • Software vendor information, including product name and support contact details. Trading partners who do their own EDI software development will also be required to submit this information.
  • NPIs for those providers on whose behalf you will be processing transactions.
  • The HIPAA 5010 transaction types you will be processing. Transactions currently supported include:

 EDI Transaction

 Description

 837 Transaction

 Two implementations of this transaction:

  • Institutional
  • Professional

 275CA Transaction

 Claim Attachment

 835 Transaction

 Claim Payment/Advice (Electronic Remittance)

 277CA Transaction

 Claim Acknowledgement

 999 Transaction

 Functional Group Acknowledgement

 

Click here to get started with the Application

Trading Partner Application

Complete the Application

A representative of your organization with appropriate authority ("Trading Partner Administrator") to enter into a Trading Partner Agreement must complete the Application. Completing the Application should take 10 - 15 minutes.

The Application includes the following sections:

What to Expect

Highmark EDI Operations will review and validate your submitted Application,  Please keep in mind that submitting complete and accurate information will ensure that your Application is processed in a timely manner. Upon successful validation, the following information will be sent via secure email to the Trading Partner Administrator:

  • Trading Partner ID
  • Login ID ("V" login)
  • Login Password
  • Written authorization for the trading partner to submit production EDI transactions

The Login ID and password provide access to Highmark's secure File Transfer Protocol (sFTP) system for the uploading and downloading of files.

Trading partners by default are enabled only for batch transactions.

More information about the Application

Trading Partner Administrator & Delegates

The Trading Partner Administrator is the primary representative of the trading partner entity (provider office, billing service, clearinghouse, etc.) that is authorized by the trading partner to conduct all electronic business on behalf of the trading partner, including entering into Trading Partner Agreements, modifying trading partner capabilities, and conducting inquiries about electronic transactions. The Trading Partner Administrator must complete the Application.

A Delegate is a representative of the Trading Partner Administrator that has been authorized by the trading partner/Trading Partner Administrator to conduct certain activities on behalf of the trading partner, such as requesting the addition or deletion of affiliated providers or conducting inquiries about electronic transactions.

Trading Partner Types

A trading partner may identify itself as a provider entity, billing service, or clearinghouse.

A trading partner may be enabled only for professional or institutional claims transactions. If your entity intends to conduct both professional and institutional claims transactions, you will need to register a separate trading partner for each transaction type.

A trading partner type of software vendor/developer also is available; however, this type will not be enabled for production transmissions.

Trading Partner Agreements

Contained within the Application is a Trading Partner Agreement with Highmark that must be accepted before the Application can be submitted. The Trading Partner Agreement, among other things, sets forth the general terms and conditions under which the trading partner agrees to exchange information electronically.

Still have questions? Please contact us. If you are ready, continue to the Application.

 

The following entities, which serve the noted regions, are independent licensees of the Blue Cross Blue Shield Association:

Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield.

Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield.

All references to "Highmark" in this document are references to the Highmark company that is providing the member's health benefits or health benefit administration and/or to one or more of its affiliated Blue companies.