Guidelines and Tips

PA Act 103 requires insurance companies to reimburse ambulance providers for the response and treatment of a member, even if the member refuses transport to an emergency department. More details are included in the document linked below.

Ambulance Treat No Transport FAQs

The following code sets were revised effective January 1, 2023 to align with Office and Outpatient Evaluation and Management (E/M) Coding Guidelines changes that were effective January 1, 2021:

Save time and money by submitting information electronically and alleviating the need for paper forms, envelopes and stamps. Highmark’s customers use our applications and systems for direct, secure, and reliable access to health care services, quality claim inquiry, and health information. Use the link below to access EDI.

EDI Trading Partner Business Center

Highmark Coding Tips is a periodic article that contains billing and coding best practices for professional and facility providers.

Highmark’s claim processing system contains various edits used to appropriately adjudicate claims. One such edit is procedure code combinations. This document lists the procedure codes with applicable component codes.

Procedure Terminology-Based Combinations

This document includes PCP billable service information for providers participating in the First Priority Health (FPH) managed care network in the 13-county Northeastern Region of Pennsylvania.

• PCP Billable Services