Need Some Claims Guidance? Check Out These Recent Articles

Since late December, we’ve published a wide range of claims-related articles on our Communications Hub.

In case you missed one or more of them, we’ve summarized them below for easy reference. If you see something that’s relevant to your practice or facility, click to read the full article.

Enhancements

Highmark Now Accepting 275 Claim Attachments via EDI

• Effective Jan. 23, 2026, we're streamlining the claims process by accepting electronic 275 Claim Attachment (CA) transactions through Electronic Data Interchange (EDI).

Updated: New Availity Functionality for High-Volume Claim Issue Inquiry

• When submitting a claim inquiry in Availity Essentials via Message this Payer, there’s a new option on the Reason for Message dropdown: High-Volume Claim Issue (HVCI). Select this option when:
  • 10 or more claims have the same claim issue/denial due to a Highmark error
  • Note: This option does not apply to provider billing errors, including accounts receivable (AR) reviews.

Policy Updates

Medically Unlikely Edits: Providers Must Bill for Individual Dates, Instead of Span Dating

• Effective March 1, 2026, Highmark’s claim systems will require professional providers to submit all HCPCS procedure codes with individual dates of service vs. a span date. This action will ensure that providers follow prior guidance and correct coding principles in claim submission. 

Update: Low Acuity Non-Emergent Professional Claim Review

• Highmark will begin reviewing Emergency Department professional claims submitted with procedure codes 99284 and 99285, which indicate moderate and high complexity levels. This will be effective for Delaware, Pennsylvania, and West Virginia on March 30, 2026, and for New York on April 27, 2026.

Facility Claims

Tips for Verifying Pricing on Facility Claims

• Reimbursement for facility claims depends on a number of factors, including contractual rates and correct coding. To gain an accurate estimate of reimbursement, follow these best practices.

Tips for Verifying Facility Pricing Part II: When Claims Are Denied

• By using the checklists in this article, you’ll have the tools to correct claims quickly, avoid submitting unnecessary inquiries, and, ultimately, improve processing of your claims. 

Coding

Preventive Lung Cancer Screening Coding

• Annual lung cancer screening (71271) and counseling (G0296) are covered under Highmark’s Preventive Schedule, but must be accompanied by the appropriate primary diagnosis code to process correctly as preventive:
  • Z87.891 (Personal history of nicotine dependence); or
  • Z122 (Encounter for screening for malignant neoplasm of respiratory organs)