Resources

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.

Resources and Reference Documents

This document addresses how trading partners conduct professional claim, institutional claim, claim acknowledgment, and claim payment advice HIPAA standard electronic transactions with IBC 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.

Addresses how employers and sponsors, or their business associates, conduct enrollment and premium payment HIPAA standard electronic transactions with Highmark. This document supplements the HIPAA mandated national implementation guides and addenda with clarifications and payer-specific usage and content requirements.

Addresses how employers and sponsors, or their business associates, conduct enrollment and premium payment HIPAA standard electronic transactions with Highmark in the 5010 version. This document supplements the HIPAA mandated national implementation guides and addenda with clarifications and payer-specific usage and content requirements.

Addresses the technical requirements for conducting inquiry transactions with Highmark in real-time mode.

Address the technical requirements for conducting claim adjudication and claim estimation transactions with Highmark in real-time mode.

Trading Partners are recommended to have a user-friendly messaging screen that can be displayed and printed for a member to show the results of a real-time claim adjudication or estimation. Highmark recommends Trading Partner's printable documents be modeled after or similar to these examples.

Trading partners who are professional or institutional providers will need to execute a Trading Partner Agreement with Highmark in order to conduct EDI business with [Company Name] via the Highmark Gateway.

Trading partners who are clearinghouses, billing services, or software vendors will need to execute a Trading Partner Agreement with Highmark in order to conduct EDI business with [Company Name] via the Highmark Gateway.

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.

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.

PWK Fax Cover Sheet

This Supplemental Claim Information Cover Sheet is used when faxing or mailing supplemental information in support of an electronic claim. See the PWK Segment instructions in the 837 sections of the Provider EDI Reference Guide for additional usage information.

Electronic Funds Transfer

For information about Electronic Funds Transfer or the EFT Attestation and Registration process, please go to the Provider Resource Center at:
https://content.highmarkprc.com/Files/EducationManuals/ProviderTraining/nn-attest-registration-guide.pdf