Highmark blue cross blue shield member claim form

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Plans are required to cover 8 tests per covered individual per 30 days, regardless of how they are packaged and distributed. Highmark members with employer-sponsored or individual health insurance coverage can seek reimbursement for the purchase of FDA emergency use authorized over-the-counter COVID tests.

Highmark Medicare Advantage members are not eligible for reimbursement at this time. The Biden Administration did not include Medicare in the coverage requirements. However, beginning April 4, individuals with Medicare Part B can get up to eight free over-the-counter tests every calendar month through the end of the COVID public health emergency from participating pharmacies or health care providers.

Click here for additional information regarding Medicare over-the-counter test coverage. Highmark Medicare Advantage members can also receive up to 24 free tests through the federal government website covidtests. Please note that there are currently limited supplies and tests may take up to 4 weeks to arrive. Note: If you do not have prescription coverage through your Highmark plan, please verify options with your employer.

Note: supplies may be limited, and tests may not be available at all retail pharmacy locations. To locate an in-network pharmacy members can visit the Highmark member website or call the number on the back of their Highmark insurance card or pharmacy benefit card for help. Just follow the step-by-step instructions found below to submit your claim via mail or through our online member portal. Members can access the Member Portal to check their claim status or contact us via the message center if the claim is not yet appearing.

If additional assistance is needed, members can call the customer service number on the back of their member identification card. You will need to submit the following documentation, following the instructions below, to receive reimbursement for your over-the-counter test:.

Note: If the Member Submitted Health Insurance Claim Form is incomplete or any of the required documentation noted above is not included with your reimbursement request your claim will be rejected with a rejection reason indicating that additional information is needed.

Box Camp Hill, PA All expenses for one patient can be submitted with one claim form. Member Discounts. Changing Coverage. Global Coverage. If you don't have your card, follow these steps to search for your local BCBS company by ZIP code or state: If you receive insurance through an employer, please enter the ZIP code or select the state of the employer's headquarters to view the BCBS companies serving that region.

If you need further help identifying your BCBS company, please contact the employer who provides your insurance for assistance. If you do not receive your insurance though an employer, please enter the ZIP code for where you live. Your local company can help you to: Change your coverage Estimate the cost of a medical procedure File or check on claim Replace your member ID card Review your balance View your plan details Looking for Insurance?

Save on products and services that enhance your health and wellness. Financial Health. Healthy Eating. Personal Care. Need to Change Coverage? Blue Cross Blue Shield can help, whether you are: Moving to a new state Changing jobs Out of work Getting ready to retire, or Your employer has stopped offering insurance.

Global Coverage Blue Cross Blue Shield companies provide a best-in-class, comprehensive suite of international products and services for people who live, work and travel internationally, giving them confidence that quality care can be accessed wherever and whenever they need it.

Current Members Blue Cross Blue Shield members have access to medical assistance services, doctors and hospitals in most countries around the world.

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This information should not be relied on as authorization for health care services and is not a guarantee of payment. Benefit plans vary widely and are subject to change based on the contract effective dates. The provider is responsible for verification of member eligibility and covered benefits. Effective dates are subject to change. Highmark will provide written notice when codes are added to the list; deletions are announced via online publication.

Examples of services that may require authorization include the following. This is not an all-inclusive list. Benefits can vary; always confirm member coverage. The online portal is designed to facilitate the processing of authorization requests in a timely, efficient manner. If you are a Highmark network provider and have not signed up for NaviNet, learn how to do so here.

Highmark recently launched a utilization management tool, Predictal, that allows offices to submit, update, and inquire on medical inpatient authorization requests.

Fax: If you are unable to use NaviNet, you may also fax your authorization requests to one of the following departments. The associated preauthorization forms can be found here. Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number , which can be found here.

Highmark contracts with WholeHealth Networks, Inc. To request an authorization for post-acute care services for Medicare Advantage members, you'll need to complete one of the following forms found here. Additional information about the programs and links to prior authorization codes are available under Care Management Programs in the left website menu. Authorization number not appearing, unable to locate member, questions about clinical criteria screen.

Contact Us. Provider Directory. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania.

Conducts research and provides updates and current status of claims edit work queues using the appropriate data management system EPIC. Resolves issues that are adversely impacting claims submission in a timely and accurate manner. Completes or requests adjustments to accounts based on dollar threshold.

Communicates information and ideas to make system-wide process improvements. Updates patient accounts regarding changes and modifications in plan benefits and other contract information relevant to the claims follow up and collection process.

Documents claim processing activity on patient accounts. Performs liaison services to both internal and external customers aiding in claims resolution. Assists with education of internal staff and external customers to bring about the timely, accurate, and cost effective adjudication of all claims.

Works collaboratively with other departments to facilitate the insurance collections process and to improve overall cash collection.

Monitors, reviews, and suggests revisions or updates to existing forms, documents, and processes required to submit a clean claim. Maintains awareness of current regulations. Initiates practices that support current regulations. Shares knowledge of current regulations with staff. Analyzes current practices and makes recommendations for process improvements. Must have knowledge of insurance billing regulations and reimbursement procedures.

Familiarity with medical terminology, ICD-9 and CPT-4 coding; third party payors in a healthcare billing environment; and Epic billing module. Introduce yourself and we'll get in touch monthly to share career insights and company news. Join Our Talent Community.