Reimbursement Resources
Find the information, tools, and guidelines you need for efficient claims submission.
Electronic Claims
Submit and track claims electronically through Highmark’s secure Availity Essentials portal at no charge.
Fee Schedule Information
Access current fee schedules for Highmark networks.
Billing Guides
Guidelines and Tips
Access documentation guidelines, coding tips, and more to simplify claims preparation.
Billing Highlights for Facilities
- wpa/ nepa
- cpa/ sepa
View billing requirements and tips for facility providers (hospitals, surgery centers, and other facility types).
Hospital OPPS Based Payment Method
- wpa/ nepa
- cpa/ sepa
- wv
- de
Learn about Highmark’s hospital outpatient prospective payment (OPPS) method and access quarterly training materials.
Facility Reimbursement Manual
- wv
This manual outlines the reimbursement process between Highmark Blue Cross Blue Shield (WV) and providers for inpatient and outpatient services.
Independent Dispute Resolution (NY)
- wny
- neny
Learn about New York’s surprise-billing Independent Dispute Resolution (IDR) process for eligible payment disputes.
Inpatient Facility Diagnosis Guidelines
These guidelines are for complex conditions to support accurate coding and reimbursement to members.
Schedules and Calendars
APC Pricing Update Calendar
View the dates when Ambulatory Payment Classification (APC) pricing components were updated and bill using current outpatient rates.
Medically Unlikely Edit (MUE) Schedule
Check the schedule of updates to Highmark’s Medically Unlikely Edit (MUE) table to help prevent claim rejections.
Codes and Bundle Rates
Lab Exempt Code List
- wny
- neny
Review the current list of CPT/HCPCS codes excluded from claims validation rules.
Therapy Bundle Payment Rate
- wpa/ nepa
- cpa/ sepa
See bundled daily reimbursement rates for PT, OT, and chiropractic services to plan costs and revenue.
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Additional Guidance
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