As noted Oct. 25, 2017, on the NaviNet® Plan Central page, Highmark will no longer accept requests for claim corrections via telephone or NaviNet investigations, effective Jan. 1, 2018. Providers instead must submit claim corrections electronically. Following are the three valid Frequency Types for claim corrections:
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Please note: The original Highmark assigned claim number is required on all Frequency Type adjustment claims (Types 7 and 8).
In the HIPAA 837P Claim Transaction, the Frequency Type Code is reported in the 2300 Loop, CLM05-3 element. The original claim number is reported in Loop 2300, ORIGINAL REFERENCE NUMBER (ICD/DCN) REF segment.
Adjusted claims can be submitted within the NaviNet® claim entry screen by selecting the appropriate frequency type code and providing the original claim number.
Additional details about electronic claims adjustment requests can be found on Page 21, Chapter 5, Unit 2, of the Highmark Blue Shield Office Manual, which is available on our Provider Resource Center under Education/Manuals.
All providers are encouraged to file electronic claims. However, effective Jan. 1, 2018, you must submit a paper replacement claim if your original claim was submitted on paper. In Box 22, enter the correct Frequency code under Resubmission code, and Original Claim Number under Original Ref. No. to indicate you’re submitting a replacement claim.