Use of Self-Service Tools Now Required for Claim Status and Claim Investigation

IN THIS ISSUE:

Use of Self-Service Tools Now Required for Claim Status and Claim Investigation

As previously announced, Highmark will require providers in our New York service areas to use our self-service tools for questions related to claim status or claim investigation beginning Aug. 1, 2024.

The Highmark Provider Service Center will no longer be able to give information regarding claims status and claims investigation for all lines of business, including the Federal Employee Program (FEP) and BlueCard*. Instead, our representatives will direct providers to our self-service tools — which are available 24/7 — and include the following:

Availity Essentials, Highmark’s Provider Portal – the primary method for submitting transactions to Highmark and accessing reports, including:
- Authorization Submission
- Claim Submissions / Investigations – The use of Availity to check claim status and submit a claim investigation is required, effective Aug. 1, 2024.
- Credentialing (Initiate Application, Submit Change, Review Status)
- Eligibility and Benefits Check
- Value Insights Center (Value-Based Program Reporting Tool)
Interactive Voice Response (IVR) – quickly manage routine inquiries, such as claim status or member benefits, without a live agent via the Provider Service Center.
Highmark’s Provider Resource Center (PRC) – the main hub for accessing important information, including policies, procedures, the Provider Manual, and Provider News.

Get More Done Faster with Our Self-Service Tools

Over the past few years, Highmark has made significant investments in our self-service tools to reduce administrative burden, improve office workflows, and simplify complex transactions — allowing you and your staff to focus on delivering care to our members.

As a result of this evolution, Highmark requires providers to utilize our enhanced self-service tools to obtain the fastest resolution to many common issues and tasks. This enables our Provider Service advocates to assist with more complex issues, while allowing your staff to avoid unnecessary hold times on the telephone.

Additional Resources

Highmark just launched a new Self-Service Tools page on the PRC to help providers and their teams to maximize these resources. By familiarizing yourself with these tools, you’ll be able to increase office efficiencies and get more done faster.

For easy reference, download our Self-Service Support Chart by clicking here.

*Highmark rolled out the same requirement in Delaware, Pennsylvania, and West Virginia last year.