Guidelines and Tips
Last Updated: Friday, January 12, 2024
- wpa/ nepa
- cpa/ sepa
Ambulance Treat/No Transport FAQs
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.
Documentation Guidelines for Evaluation and Management Services
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:
Electronic Data Interchange (EDI) Services
Providers who are interested in integrating real-time capabilities within their practice management system should discuss this functionality with their software vendors and review Highmark’s EDI website.
Choose the applicable link below to review our EDI transaction and connectivity specifications in the Resources section of the website:
- Delaware: https://edi.highmark.com/edi-bcbsde/index.shtml
- New York: https://www.ask-edi.com
- Pennsylvania: https://edi.highmark.com/edi/index.shtml
- West Virginia: https://edi.highmark.com/edi-wv/index.shtml
- wpa/ nepa
- cpa/ sepa
- wv
Guidelines for Humanitarian Use Devices (HUDs)/Humanitarian Device Exemptions (HDEs)
This document contains information on HUDs and how to apply for approval through the Food and Drug Administration (FDA).
Highmark Coding Tips
Highmark Coding Tips is a periodic article that contains billing and coding best practices for professional and facility providers.
Procedure Terminology-Based Combinations
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.
- wpa/ nepa
First Priority Health Network
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.
