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NOVEMBER 2021CHAPTER 6: BILLING AND PAYMENTUNIT 2: ELECTRONIC CLAIM SUBMISSIONIN THIS UNITTOPICSEE PAGEBenefits of Electronic Claim SubmissionHighmark EDI Services SupportRequired Electronic Claim Submission FormatsSubmitting Claims (New York Only) UPDATED!Real-Time Estimation and AdjudicationClaims Record ManagementAttachments for Electronic ClaimsNAIC Codes UPDATED!Electronic Claim Status InquiriesNaviNet 1500 and UB Claim SubmissionDisclaimers245613161920232529What Is My Service Area?HIGHMARK PROVIDER MANUAL Chapter 6.2Billing & Payment: Electronic Claim Submission1 P a g e

NOVEMBER 20216.2 BENEFITS OF ELECTRONIC CLAIM SUBMISSIONIntroductionAll it takes is a computer, the proper software, and an Internet connection forelectronic claims submission. Instead of printing, bundling, and sending paperclaims through the mail, simply enter and store claims data through your officecomputer.Faster claimpaymentElectronic claims are convenient, confidential, and operational around the clock.Highmark’s claim processing system places a higher priority on claims filedelectronically. Electronic claims will typically process in seven (7) to fourteen (14)calendar days, whereas paper claims will process in twenty-one (21) to twentyseven (27) calendar days.What Is My Service Area?RegulatorycomplianceThe payment progress targets defined above that are used in Pennsylvania are incompliance with timely claims payment regulations defined by Pennsylvania’s Act68, and reflect processing of clean claims that do not require manual interventionor investigation.The payment progress targets defined above that are used in Delaware are incompliance with timely claims payment regulations defined by DelawareInsurance Regulation 1310, and reflect processing of clean claims that do notrequire investigation.In West Virginia, the payment progress targets defined above are used and are incompliance with the timely claims payment regulations defined by the Ethics andFairness In Insurer Business Practices Act, W.Va. Code §33-45-1 et seq., commonlyreferred to as the “Prompt Pay Act”, and reflect processing of clean claims that donot require investigation.For more information on these regulations, please see the manual’s Chapter 6.1:General Claim Submission Guidelines.CosteffectiveElectronic claim submission increases staff productivity by speeding claimpreparation and delivery. Many of the paper claim processes are eliminated suchas form printing, bundling, postage, and mailing.Many errors experienced in the keying and processing of paper claim forms arereduced or eliminated. Electronic claim submission means greater claimacceptance rates and reduced staff time in claim research and resubmissions.Continued on next pageHIGHMARK PROVIDER MANUAL Chapter 6.2Billing & Payment: Electronic Claim Submission2 P a g e

NOVEMBER 20216.2 BENEFITS OF ELECTRONIC CLAIM SUBMISSION, ContinuedConvenientandconfidentialElectronic submission provides the added benefit of both claim preparation anddelivery at your convenience. Postal service hours of operation or delays do notlimit your productivity. Electronic claims can be submitted 24 hours a day, sevendays a week, 365 days a year. It is safe, immediate, and direct to Highmark. EDIsecurity standards are in place to ensure your claim data remains confidential andsecure.NaviNet claimsubmissionHIPAA-compliant 1500 (837P) and UB (837I) claim submission transactions areavailable to participating professional providers and facilities in NaviNet.What Is My Service Area?FOR MOREINFORMATIONFor information on signing up for EDI and also NaviNet, please see the manual’sChapter 1.3: Electronic Solutions – EDI & NaviNet.To learn more about electronic claims submission, visit the Electronic DataInterchange (EDI) Services website. You can access the site by selecting CLAIMS,PAYMENT & REIMBURSEMENT from the main menu on the Provider ResourceCenter, or by clicking the applicable link below to access the site directly: Pennsylvania: highmark.com/edi Delaware: highmark.com/bcbsde West Virginia: highmark.com/edi-wv New York: https://www.ask-edi.com/HIGHMARK PROVIDER MANUAL Chapter 6.2Billing & Payment: Electronic Claim Submission3 P a g e

NOVEMBER 20216.2 HIGHMARK EDI SERVICES SUPPORTOverviewThe Highmark EDI Operations support staff is comprised of trained personneldedicated to supporting electronic communications. They provide informationand assistance with questions or problems you encounter with any aspect of yourEDI transactions.Support is free and staff is available Monday through Friday from 8 a.m. to 5 p.m.To save time when calling, be prepared to provide your Trading Partner number,NPI, and log-on identification to the support analyst.What Is My Service Area?EDI phonecontactDelaware, Pennsylvania, and West Virginia:To contact a support analyst by phone, call 1-800-992-0246.New York:For support, call Administrative Services of Kansas at 1-800-472-6481Accessible24 hours a day,7 days a weekElectronic transactions can be sent and retrieved seven days a week, 24 hours aday. Electronic transactions can be submitted once or multiple times per day orweek. Claim transmittal and report retrieval schedules are controlled by eachoffice.Information on EDI Claim Submission can be found on the EDI website by visitingthe Electronic Data Interchange (EDI) Services website via the ProviderResource Center, or by clicking the applicable link below to access the site directly: Pennsylvania: highmark.com/edi Delaware: highmark.com/bcbsde West Virginia: highmark.com/edi-wv New York: https://www.ask-edi.com/The EDI website has the most up-to-date information about doing businesselectronically with Highmark. Highmark recommends that you bookmark this siteand consider it your first source when you have a problem or question.HIGHMARK PROVIDER MANUAL Chapter 6.2Billing & Payment: Electronic Claim Submission4 P a g e

NOVEMBER 20216.2 REQUIRED ELECTRONIC CLAIM SUBMISSION FORMATSBackgroundIn 1979, the American National Standards Institute (ANSI) chartered the AccreditedStandards Committee (ASC) X12 to develop and maintain uniform standards forElectronic Data Interchange (EDI). ASC X12N is the section of ASC X12 for thehealth insurance industry’s administrative transactions.Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), theAdministrative Simplification provisions named ASC X12N as the mandatedstandard to be used for electronic transmission of health care transactions.Required claimsubmissionformatThe current HIPAA electronic transaction standards for health care eligibility, claimstatus, referrals, claims, and remittances are the ASC X12N Version 5010transactions. The required formats for electronic claim submission are: Professional: ASC X12N 837 Health Care Claim: Professional TransactionVersion 005010 (“837P”) Institutional: ASC X12N837 Health Care Claim: Institutional TransactionVersion 005010 (“837I”)Types ofelectronicsubmissionThe following types of electronic claim submission are available to participatingfacilities: Batch submission and Real-Time Estimation/Adjudication (limited to asingle claim) via any electronic data interchange vendor NaviNet UB Claim Submission Professional providers have the following options: Submission via any electronic data interchange vendor or billing service NaviNet 1500 Claim SubmissionNote: The NaviNet claim submission transactions are compliant with the HIPAA837P and 837I formats.HIGHMARK PROVIDER MANUAL Chapter 6.2Billing & Payment: Electronic Claim Submission5 P a g e

NOVEMBER 20216.2 Submitting Claims (New York Only)SubmittingClaimsTo improve accuracy and timeliness of paper claim submissions, we utilizeOptical Character Recognition/Intelligent Character Recognition (OCR/ICR). Tomaximize the efficiency of this technology, we are asking providers who submitpaper claims to use the red CMS 1500 (2-12) or UB-04 standard claim forms.NOTE: Edits for electronic claims and paper claims are exactly the same.Submitting a paper claim that originally rejected electronically without fixing theproblem will only lead to a rejection of the paper claim as well.All claims for Medicare covered services and items that are the result ofphysician's order or referral shall include the ordering/referring physician's name,NPI, and taxonomy code in boxes 17, 17a, and 17b of the CMS 1500 claim form.The following services/situations require the submission of the referring/orderingprovider information. This is not an all-inclusive list: Medicare covered services and items that are the result of a physician'sorder or referral Parenteral and enteral nutrition immunosuppressive drug claims Hepatitis B claims Diagnostic laboratory services Diagnostic radiology services Portable x-ray services Durable medical equipmentWhen the ordering physician is also the performing physician (as often is the casewith in-office clinical laboratory tests)Claimsubmissiontips Use the red CMS 1500 or UB-04 claim forms.Check your printer to ensure that your ink is dark.Do not highlight data on the claim form.Check your printer to ensure that it is lined up with the fields on the claimform.If the information submitted is incorrect or missing, we may generate aletter asking you to resubmit the claim with the correct information.The use of any other type of CMS1500 or UB-04 claim forms other thanthe red forms will delay processing.Paper claims must have a physical address in box 33; if a PO Box issubmitted, the claim will be returned for correction and resubmission.ZIP codes must be submitted with 9 digitsInclude the referring/ordering physician NPI as required by CMS billingrequirements.Continued on next pageHIGHMARK PROVIDER MANUAL Chapter 6.2Billing & Payment: Electronic Claim Submission6 P a g e

NOVEMBER 20216.2 Claims (New York Only), ContinuedSubmittingAppealsSubmit all timely filing appeal requests in writing, stating the reason for the delayof submission beyond 365 days. The claims you are appealing must be on paperand attached to your appeal. Please keep copies of the information you send forease in identifying claims that will be approved/denied.Why blue italics?Electronically Submitted Claims:For electronic claims that have not been processed, please submit one of thefollowing reports with your appeal request and claim(s): Deleted Claim Edit Report Clearinghouse Response filesIf you would prefer to receive these reports instead of your vendor, pleasecontact ASK at 1-800-472-6481.If you are using the electronic response file to do automatic posting of errors orclaims accepted, the following information needs to be included on the reportyou send to us: Error record Record sequence Error code Clearinghouse messages Error field Error descriptionContinue to balance your submission counts to those on the ClearinghouseResponse file. If a discrepancy exists between the counts, notify our Help Deskimmediately. The Clearinghouse Response file will be the only notification youwill receive about a claim deleted in the transmission.If you currently do not receive any of the above reports or experiencediscrepancies on claim counts, contact ASK at 1-800-472-6481.ClearinghouserejectionsIf a claim rejects in the clearinghouse (i.e., invalid member identification number),submit your deleted claim edit report and claim with your appeal.Continued on next pageHIGHMARK PROVIDER MANUAL Chapter 6.2Billing & Payment: Electronic Claim Submission7 P a g e

NOVEMBER 20216.2 Claims (New York Only), ContinuedCoordinationof benefitsIf an insurance carrier other than Highmark Blue Cross Blue Shield of WesternNew York or Highmark Blue Shield of Northeastern New York is the primarycarrier, then providers must submit the other carrier's payment voucher andclaim within three months of the payment from the other carrier. COB claims canbe submitted using the 8371 or 837P. Providers do not need to submit the othercarrier explanation of benefits (EOB) if all of the information is submitted on the837.If a provider is receiving an 835 (electronic remittance), they may or may not havea paper voucher or EOB to submit to Highmark Blue Cross Blue Shield of WesternNew York or Highmark Blue Shield of Northeastern New York. The informationreceived on the 835 should be incorporated into the secondary fields on the 837.IncorrectinsuranceinformationIf the member provided incorrect insurance information, the denial notice fromthe other carrier must be submitted with the original claim within three monthsof the other carrier's denial.Why blue italics?No CoverageIf a participating provider, in dealing with a patient finds that he/she has noinsurance, the member should be asked to sign and date a patient responsibilityform or waiver.A provider may seek payment from the patient for any services provided.If the member realizes that he or she has Highmark Blue Cross Blue Shield ofWestern New York or Highmark Blue Shield of Northeastern New York coverageafter a provider has billed the member and the claim is beyond the 365-daytimely filing limit, the provider should submit the signed waiver/patientresponsibility form and claim with your appeal. Do not re-bill the member.If you do not have a signed waiver, submit copies of billing statements with yourclaim(s) and appeal that indicates that you have billed the member who has nowadvised you that he/she has Highmark Blue Cross Blue Shield of Western NewYork or Highmark Blue Shield of Northeastern New York insurance.Member heldharmlessParticipating providers are responsible to abide by the stipulations of theHighmark Blue Cross Blue Shield of Western New York or Highmark Blue Shield ofNortheastern New York provider agreements. In cases where services were notbilled to us within the timely filing limits, you cannot bill the member directly.Continued on next pageHIGHMARK PROVIDER MANUAL Chapter 6.2Billing & Payment: Electronic Claim Submission8 P a g e

NOVEMBER 20216.2 Claims (New York Only), ContinuedMember heldharmless(Continued)The member is to be held harmless. The reimbursement issue is between you as aparticipating provider and us as the insurer. You may file the claim late with arequest to waive the limit with an explanation. Upon review of your appeal,approval or denial will be determined. However, at no time is the member to beheld responsible.Filingrequirementsfor membersand nonparticipatingprovidersClaims submitted by members or non-participating providers (for traditional andapproved services through our managed care contracts) must be submittedwithin the following time frames: Major Medical: 12 months Traditional: 12 monthsClaimAdjustmentPolicyEffective January 1, 2005, Highmark Blue Cross Blue Shield of Western New Yorkand Highmark Blue Shield of Northeastern New York implemented a standardclaim adjustment policy for all providers.If claims, requests for adjustments, appeals or claim reviews are submitted by themember or a non participating provider after the above time frames, the claimwill be denied. The non-participating provider can bill the member for thesedenied claims.Blue Cross Blue Shield will accept claim adjustment requests up to 180 days fromthe end of the calendar year in which the claim in question was adjudicated.Adjustment requests received after that time frame has expired will not beprocessed.Additionally, Blue Cross Blue Shield will not initiate any retroactive claimadjustment activities after the 180- day timeframe has expired for paid claims.Exclusions tothis policy Claims investigated as part of an internal audit for fraud, waste or abuseare exempt from this policy and are subject to payment recovery.Coordination of Benefits (COB) and Other Party Liability (OPL) situationsare exempt from this policy. Consideration of claims/adjustments will bebased on current COB/OPL timely filing guidelines. In the case of No Faultand Other Insurance situations, submissions and adjustment requestsmust be received within 120 days of the other carrier's process date.Claims that are related to Workers' Compensation are not subject totimely filing limitations.Continued on next pageHIGHMARK PROVIDER MANUAL Chapter 6.2Billing & Payment: Electronic Claim Submission9 P a g e

NOVEMBER 20216.2 Submitting Claims (New York Only), ContinuedNew YorkState promptpay interestPrompt Pay Interest exceeding 1.99 per claim is generated on a daily basis forclaims not processed within 30 days of Blue Cross Blue Shield's receipt of theclaim. Checks and wire payments are issued more frequently than the weeklycycle to ensure that prompt pay requirements are met. Any interest paid appearsunder the "Interest Paid" column on your payment voucher.Claims submitted for adjustment due to errors caused by Blue Cross Blue Shieldprocessing receive prompt pay interest.The following are excluded from prompt pay interest: Administrative Services Only (ASO) & Administrative Services for NationalAccounts (NSO) contracts Federal Employee Plan (FEP) contracts Services rendered by out-of-state providers Senior Blue and BlueSaver claims from non-participating providers National Accounts, when an out-of-state Plan, is the control Plan Blue Card claims for Members from Plans outside New York State, homeand host If you are a capitated provider billing for fee-for-serviceprocedures, prompt pay interest will be calculated for those claims, ifnecessary.Coordinationof benefitspaymentsCoordination of benefits applies to members who have more than one grouphealth insurance contract. Blue Cross Blue Shield coordinates benefit paymentswith other carriers to ensure members receive all of the benefits to which theyare entitled and to prevent duplicate payments. Other insurance informationshould be verified each time that a patient visits your office.Priorauthorizationand referralrequirementsFor managed care (including POS in-network claims), all priorauthorization/referral policies and procedures apply, even though Blue CrossBlue Shield may be the secondary payer.For Preferred Provider Organization (PPO) contracts, all prior authorizationpolicies and procedures apply, even though Blue Cross Blue Shield may be thesecondary payer.If appropriate prior authorization of services has not been made, or if a validreferral has not been issued before processing a claim, we may deny paymenteven on a secondary basis if the services are determined not to be medicallynecessary.Continued on next pageHIGHMARK PROVIDER MANUAL Chapter 6.2Billing & Payment: Electronic Claim Submission10 P a g e

NOVEMBER 20216.2 Submitting Claims (New York Only), ContinuedPrimacyWhen a patient is covered by two or more health insurance plans, one plan isdetermined to be primary and its benefits are applied to the claim. The followingrules apply when determining which carrier is primary:1. If one policy does not have a COB provision, then it will be primary.2. If the patient is covered under one policy as the employee and underanother policy as a dependent, the policy which covers the patient as anemployee will be primary.3. The primary policy for children is the policy of the parent whose birthday(month and day) falls earlier in the year. If both parents have the samebirthday, the policy that covered the parent longer is primary.4. When there is more than one insurance policy and the parents aredivorced or separated, the rules of primacy vary depending on the courtdecision.5. If the patient is the policy holder and covered under one of the policies asan active employee, neither laid off nor retired, and also covered underanother policy as a laid off or retired employee, the policy covering thepatient as an active employee will be primary.6. If none of the above applies, then the policy that has covered the patientfor the longest time will be primary.Submittingclaims forsecondaryreimbursementClaims must be submitted electronically in the 837P or 8371 format, or on paperusing a CMS 1500 or UB-04. All line items billed to the primary carrier should besubmitted on the secondary claim.Attach a copy of the primary carrier's Explanation of Benefits Statement andindicate balance due. The balance due is the amount to be considered by BlueCross Blue Shield or the patient's responsibility.Attach a copy of the primary carrier's Explanation of Benefits Statement. Claimssubmitted on paper without the Explanation of Benefits Statement, will berejected.PPO or POSclaimsWhen a claim for Traditional, PPO or POS out-of-network services is secondary,our payment will not exceed our allowance for the services. Also, the sum of theprimary and secondary payments will not exceed the provider's charge.Continued on next pageHIGHMARK PROVIDER MANUAL Chapter 6.2Billing & Payment: Electronic Claim Submission11 P a g e

NOVEMBER 20216.2 Submitting Claims (New York Only), ContinuedBill your usualchargeRegardless of our allowance for a service, you should always bill your usualcharge. This is beneficial in several ways:1. It enables us to determine average charges for procedures.2. By using one charge to bill all insurance companies, the chance of billingerrors is reduced.3. If more than one insurance company has liability for a claim, yourstandard charge eliminates confusion and helps to ensure properpayment.4. Professional Courtesy - No reimbursement will be provided to aprovider billing for professional services rendered to his/her immediatefamily, regardless of whether the family member has coverage under aBlue Cross Blue Shield contract. Immediate family is defined as theprovider's spouse, children, parents, and siblings. Blue Cross Blue Shieldwill not reimburse for services that would normally have been furnishedwithout chargeHIGHMARK PROVIDER MANUAL Chapter 6.2Billing & Payment: Electronic Claim Submission12 P a g e

NOVEMBER 20216.2 REAL-TIME ESTIMATION AND ADJUDICATIONIntroductionHighmark’s Real-Time tools are available to all NaviNet -enabled contractedproviders and to providers who submit electronic claims through a practicemanagement system. These primary Real-Time capabilities include Real-TimeProvider Estimation and Real-Time Claims Adjudication.These real-time capabilities give providers the ability to discuss member financialliability with patients when services are scheduled or provided. Providers couldalso collect applicable payment or make payment arrangements at the time ofservices, if they wish to do so.Real-TimeProviderEstimationThe Real-Time Provider Estimation tool gives providers the ability to submitrequests for specific health care services before or at the time services arerendered and receive a current estimate of the member’s financial liability withinseconds before the services are rendered.The estimate takes into account the cost of the service provided and the amountof the deductible, coinsurance, and/or copayment and other coverage provisionsincluded in the member’s benefit program. This information, in turn, can beutilized to set the member’s cost expectations prior to receiving services andcollect or make arrangements for payment at the time of service. This function inNaviNet also allows the provider to print and give the member a Highmark RealTime Member Liability Statement-Estimate for his/her records.This tool should be used to give members an accurate estimate of their financialobligations prior to or at the time of service. To determine member liability afterservices are rendered, it is recommended that providers use the real-time claimsadjudication tool (see below).In NaviNet, we also make it is easy to turn a real-time estimation into a real-time1500 Claim Submission with just a click of a button. For instructions on 1500 Claimand Estimate Submission, tutorials are available in the NaviNet User Guides. SelectHelp from the NaviNet toolbar to access them in NaviNet Support.Note: Real-Time Estimation can be used for all Highmark products; however,estimate submission is not available for the Federal Employee Program (FEP).Continued on next pageHIGHMARK PROVIDER MANUAL Chapter 6.2Billing & Payment: Electronic Claim Submission13 P a g e

NOVEMBER 20216.2 REAL-TIME ESTIMATION AND ADJUDICATION, ContinuedReal-TimeClaimsAdjudicationThe Real-Time Claims Adjudication tool gives providers the added ability to submitclaims for specific health care services and receive a fully adjudicated responsewithin seconds. This allows providers to determine, at the time of service, thecorrect amount the member owes. This, in turn, enables the provider to collectpayment or make payment arrangements for the member’s share of the cost atthe time of service.This function in NaviNet also allows the provider to print a Highmark Real-TimeMember Liability Statement to give to the member for his/her records.AcceleratedProviderPaymentAccelerated Provider Payment allows providers who meet certain criteria toreceive accelerated payment on real-time submitted claims. Providers will receivemore frequent payments from Highmark -- within three (3) business days forclaims that have been submitted in real-time.Note: Accelerated payment does not apply to amounts paid from the member’sconsumer spending account.Acceleratedmember EOBon memberportalAccelerated Explanation of Benefit (EOB) displays the member explanation ofbenefits (EOB) on the Highmark Member portal the next business day for all realtime submitted claims.Refundingthe memberThese Real-Time Capabilities allow providers to get fast, current, and accurateinformation to help in determining the patient’s financial liability prior to or at thetime of service. The provider tools will be especially useful as the member costsharing increases and the use of spending accounts grow.Please note, however, that if you collected payment from the member at the timeof service for member liability, and then subsequently receive payment fromHighmark and find an overpayment, be sure to issue the refund directly to themember within thirty (30) calendar days.NaviNetUserGuidesUser Guides are available in NaviNet for real-time estimate submission and claimsubmission. To access NaviNet User Guides for both professional and facilityproviders, select Help from the toolbar, click on the Health Plan tab, and thenselect the applicable Highmark option for your service area.Continued on next pageHIGHMARK PROVIDER MANUAL Chapter 6.2Billing & Payment: Electronic Claim Submission14 P a g e

NOVEMBER 20216.2 REAL-TIME ESTIMATION AND ADJUDICATION, ContinuedElectronic DataInterchange(EDI) ServicesProviders who are interested in integrating real-time capabilities within theirpractice management system should discuss this functionality with their softwarevendors. They should also review the Electronic Data Interchange (EDI) transactionand connectivity specifications in the Resources section on the EDI website.To access the EDI website from the Provider Resource Center, select CLAIMS,PAYMENT & REIMBURSEMENT from the main menu, or click on the applicablelink below to access the applicable site directly: Pennsylvania: highmark.com/ediDelaware: highmark.com/bcbsdeWest Virginia: highmark.com/edi-wvNew York: https://www.ask-edi.com/What Is My Service Area?HIGHMARK PROVIDER MANUAL Chapter 6.2Billing & Payment: Electronic Claim Submission15 P a g e

NOVEMBER 20216.2 CLAIMS RECORD MANAGEMENTOverviewHighmark provides electronic acknowledgments to enhance your ability to trackand monitor your claim transactions.AcknowledgmenttransactionsElectronic claims can be submitted via the 837 Professional (837P) andInstitutional (837I) Health Care Claim Transactions. Upon receipt of the 837transaction, there are several acknowledgment transactions available for trackingelectronic claim submissions and payment depending on the capabilities of yoursoftware: 999 – Implementation Acknowledgment for Health Care Insurance 277CA– Claim Acknowledgement 835– Electronic Remittance Advice ERAIMPORTNANT!Highmark Blue Cross Blue Shield of Western New York and Highmark Blue Shieldof Northeastern New York providers will receive electronic claims informationfrom Administrative Services of Kansas (ASK -EDI).999 –ImplementationAcknowledgmentfor Health CareInsuranceWhen transmitting claims in HIPAA Version 5010, you will receive the005010X231 999 Transaction verifying that Highmark received your claim(s) fileand indicating whether the file was “accepted” or “rejected” for further claimediting.277CA –Health Care ClaimAcknowledgmentThis transaction is available approximately 24 hours after an accepted/acceptedwith errors 999 Implementation Acknowledgment for Health Care Insurancereport is accepted. After the EDI claim editing process is complete, you are able toverify through the 277CA Claim Acknowledgment transaction that your claimswere accepted and forwarded for claims processing. The 277CA also identifiesclaims that did not pass or were rejected by the editing process due to dataerrors.Continued on next pageHIGHMARK PROVIDER MANUAL Chapter 6.2Billing & Payment: Electronic Claim Submission16 P a g e

NOVEMBER 20216.2 CLAIMS RECORD MANAGEMENT, Continued277CA –Health CareClaimAcknowledgment (Continued)The 277CA should be reviewed after every accepted/accepted with errors claimfile transmission because it provides a valuable and detailed analysis of yourclaim file. Claims that were accepted should not be resubmitted. Highmark willno longer attempt to correct or retrieve missing information -- this rejectedclaim data must be corrected and the claim resubmitted electronically.Trading partners submitting 837 claim transactions in Version 5010 must be ableto accept the 005010X214 277 Health Care Claim Acknowledgment (277CA)Transaction.835 –Health CareClaimPayment/Advice(ElectronicRemittanceAdvice - ERA)The 835 Health Care Claim Payment Advice, or Electronic Remittance Advice (ERA),is essentially an electronic version of a paper Explanation of Benefits (EOB) orremittance. When 835 ERA information is combined with an

6.2 HIGHMARK EDI SERVICES SUPPORT . Overview . The Highmark EDI Operations support staff is comprised of trained personnel dedicated to supporting electronic communications. They provide information and assistance with questions or problems you encounter w