Non-Participating Providers Required to Use Self-Service Tools for Claim Status and Claim Inquiry

Effective Sept. 30, 2024, all non-participating providers — those in Delaware, Pennsylvania, New York, and West Virginia who are not currently contracted with Highmark — will be required to use Availity or our Interactive Voice Response (IVR) system to check claim status or submit a claim inquiry for a Highmark member.

This change is for commercial, Federal Employee Program (FEP), and BlueCard (Medicare Advantage excluded) claims.

For out-of-area non-participating provider BlueCard claims for Highmark members, please use your local plan's provider portal to check status and submit claim inquiries.


These self-service tools are available 24/7 and can provide the quickest answers to your claim questions.

  1. Availity Essentials, Highmark’s Provider Portal – the primary method for submitting transactions to Highmark.

    Because Availity is a multi-payer platform, even if you are not contracted with Highmark, you can register your organization to transact with Highmark and other payers across the country.

    If your organization is not already registered with Availity, go to the Register and Get Started with Availity Essentials webpage for details on how to register. We recommend you begin the Availity registration process now to ensure you have access prior to Sept. 30.

    For more information on how to check claim status or submit a claim inquiry in Availity, we have a special section on the Highmark Provider Resource Center.


  2. Interactive Voice Response (IVR) – An automated, interactive telephone system that allows providers to inquire about claim status.

    • You can access the following claim information via the IVR:
      • Charges
      • Process date
      • Member responsibility

    • Be prepared with the provider’s NPI number; member’s Highmark ID or Social Security number; member birthdate; and date of service.

Beginning Sept. 30, 2024, non-participating providers who call Highmark Provider Service Center for questions relating to claim status or claim inquiry will be directed to use Availity or the IVR.

Effective July 2023, Highmark participating providers in Delaware, Pennsylvania, and West Virginia were required to use Availity or the IVR for claim status and claim inquiry. The same requirement went into effect in New York in August 2024.


 

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