Why Is This Change Happening?

There are several reasons why we are making this change:

• Our electronic, self-service tools — available 24 hours a day — are the fastest and most effective ways for providers to get answers to routine claim inquiries.
• Phone calls take more time, are less efficient, and can only be processed during normal business hours.
• Call volumes at Highmark have remained higher than normal, resulting in extended wait times, even with increased support within our call centers. Many of these calls are for routine claim inquiries, which delays responses to urgent and more complex matters.

Shifting all routine claim inquiries to our self-service tools will help reduce wait times and allow you to speak more quickly to a provider representative when you have a unique or urgent need.

Self-Service Tools – Answers at Your Fingertips

The Provider Call Center will no longer be able to provide information regarding claim status and claim inquiry.* Instead, our representatives will direct you to our self-service tools that are available by logging into NaviNet^® or by using our Interactive Voice Response (IVR) system.

These tools are the preferred way to get quick answers for many needs, including:

• Claim status inquiries
• Claim investigations

*This does not apply to our FEP business or our NY and SEPA regions at this time.

NaviNet

NaviNet’s Quick Start Guide — available on the Provider Resource Center — has step-by-step procedures for conducting both claim status inquiries and claim investigations. The guide features easy-to-follow instructions accompanied by screenshots showing users what to do during each step.

The Claim Status Inquiry function allows you to view real-time, detailed claim information for any member, whether claims were submitted electronically or on paper. You can track the status of a claim from the start of the adjudication process until the time of payment.

IVR

Highmark’s IVR system enables providers and their teams to make routine claim inquiries via telephone. To check on the status of a claim, follow these steps:

• Call the Provider Service Center for your region.
• Enter the following information:
• Provider’s NPI number.
• Member’s Highmark ID or Social Security number.
• Member’s birthdate.
• Say “Claims” and then enter or say the date of service.

The system will provide a summary of the claim, including service date(s), charges, process date, and member responsibility. If you ask for “More Details,” you will also receive information, such as claim number, the number of charges on the claim, provider responsibilities, and paid amount.

For more information regarding Highmark’s self-service tools, see the recent Special Bulletin .

  

Provider News, Issue 7, July 2023   |   © 2023 Highmark Blue Shield