Reimbursement Resources
Find the information, tools, and guidelines you need for efficient claims reimbursement.
More Resources
Billing Highlights for Facilities
- wpa/ nepa
- cpa/ sepa
See the documents identifying information required to bill facility types. Plus get tips on how to provide the right information for each facility type.
APC Pricing Component Update Calendar
Find a record of the dates on which the Ambulatory Payment Classification (APC) pricing components were last updated.
Hospital OPPS Based Payment Method
- wpa/ nepa
- cpa/ sepa
- de
- wv
Access Highmark's Hospital Outpatient Prospective System (OPPS) Based Payment Method Training Manual and change documentation for each quarter.
Facility Reimbursement Manual
- wv
This manual outlines the reimbursement process between Highmark Blue Cross Blue Shield (WV) and providers for inpatient and outpatient services.
Medically Unlikely Update Schedule
View the dates on which Highmark updated its Medically Unlikely Edits (MUE) Table.
Electronic Data Interchange (EDI)
GO TO EDI: Delaware | New York | Pennsylvania | West Virginia
Physical Therapy, Occupational Therapy, and Chiropractic Daily Bundle Maximum
Highmark's bundled daily reimbursement rate helps providers and members know the cost of treatment in advance, helping providers predict revenue, collect member cost share at the time of service, and improve member experience.
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