Reimbursement Resources
Find the information, tools, and guidelines you need for efficient claims reimbursement.
More Resources
Find the information you need for successful reimbursements.
Billing Highlights for Facilities
- wpa/ nepa
- cpa/ sepa
See the list of documents identifying the information required to bill specific facility types. Plus get helpful 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 Outpatient Prospective System (OPPS) Based Payment Method
- wpa/ nepa
- cpa/ sepa
- de
- wv
Access Highmark's Hospital OPPS Based Payment Method Training Manual and Change Documentation for each quarter.
Facility Reimbursement
- wv
Outline the reimbursement process between Highmark West Virginia and provides for inpatient and outpatient services, as defined in the provider agreement, ensuring compliance with all terms and conditions of the agreement and manual.
Medically Unlikely Update Schedule
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 you predict revenue, collect member cost, share at time of service, and improve member experience.
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