Highmark billing and credentialing
Billing and credentialing for Highmark Blue Cross Blue Shield plans.
Working with Highmark
Highmark is the Blue plan in much of Pennsylvania, plus West Virginia, Delaware and western and northeastern New York, offering commercial and Medicare Advantage plans.
Plan types we bill:
- Commercial plans
- Medicare Advantage
Credentialing and enrollment
Credentialing uses your CAQH ProView profile, which must be complete and re-attested every 120 days.
Prepare
Licenses, NPI, CAQH and group details checked and updated.
Apply
Application submitted for each provider and location.
Follow up
Status checked every 1 to 2 weeks until approval.
Confirm
Effective date and participation confirmed before billing.
Claims, eligibility and portals
Highmark uses Availity for eligibility, claims and authorizations.
Denials we prevent with Highmark
- Provider not credentialed or not linked to the group
- Out-of-area members not billed through BlueCard
- Missing prior authorization
- Coding and bundling edits under plan policy
- Late filing under the contract
Questions about Highmark
Does Highmark handle BlueCard claims?
Yes, in its service areas, for out-of-state Blue members.
Trademarks belong to their owners. MedAi Billing Solutions is an independent billing company, not affiliated with any payer or government agency.
Get help with Highmark claims
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.