Claims and Medical Policies

Claims and Payment Policies

Highmark Health Options processes medical expenses upon receipt of a correctly completed CMS-1500 form for professional services and upon receipt of a correctly completed UB-04 form for hospital or facility expenses. Paper claim forms must be submitted on original red claim forms. A claim without valid, legible information in all mandatory categories is subject to rejection or denial. To ensure reimbursement to the correct payee, the group NPI must be included on every claim. Refer to the Provider Manual for additional Claims information.

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Medical Policies

Highmark Health Options medical policies explain the medical services we may or may not cover. They are based on objective, credible sources, such as the latest scientific literature and citations, guidelines from nationally recognized health care organizations, evidence-based consensus statements, and expert opinions from our medical directors.

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