Claims, Payment, Reimbursement, and Medical Policies

Highmark Health Options covers medical services based on credible sources like scientific literature, guidelines from recognized healthcare organizations, consensus statements, and expert opinions from medical directors. We process claims upon receiving correctly completed CMS-1500 forms for professional services and UB-04 forms for hospital or facility expenses. Paper claim forms must be submitted on original red forms with all mandatory information. Claims without valid information may be rejected. The group NPI must be included on every claim for proper reimbursement. Refer to the Provider Manual for more Claims information.