Short Takes: Member ID Cards, Billing, and Claims AdjustmentsIf a patient’s last name is missing a letter on his or her member ID card, claims should still be submitted with the patient’s complete first and last name.
As a reminder, to ensure your claims are processed correctly, you must bill using your patient’s NEW member ID and include the full number. If you are submitting paper claims, please make sure that you are mailing them to the correct PO Boxes.
Paper claims for your patients on Highmark’s system can be mailed to:
PO Box 4208 |
Paper claims for patients still on our Legacy system should be sent to:
PO Box 80 |
In addition, with Highmark contracting at the group level, the claims system requires that the billing provider be submitted as a group provider and not as an individual one.
Providers have 365 days from the date of service or date of discharge (for inpatient claims) to request an adjustment on a claim or to submit any corrections for both Legacy and Highmark system patients.
For example, if a claim has a date of service August 1, 2022, you will have until July 31, 2023, to submit an adjustment request on that claim.
