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

Providers have a new tool in Availity Essentials for streamlining the review of high-volume claim issues when the issue is the same for each claim and is due to a Highmark error. 

When submitting a claim inquiry in Availity 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.

What to Include in Your Claim Inquiry

• Detailed information regarding the similar issue affecting these claims. A separate inquiry is not needed for each claim.
• The following information must be included:
  • Claim numbers (a minimum of 10)
  • Member IDs
  • Patients’ names
  • Patients’ DOBs 
  • Dates of service, including date span, if applicable
  • Total charges for each claim
  • Contact name on the provider’s team and phone number

Three Possible Outcomes for an HVCI

1. Highmark – If it’s determined that the claim denials are due to a Highmark error, this inquiry will be handled as a special project, and the provider will be updated via the portal. 
2. Provider – If the issue is due to a provider error, the investigation will be closed with an explanation sent to the practitioner.
3. Variety of Issues – If the denials are due to a variety of unrelated issues, the inquiry will be returned to the provider advising: 
   • “This is not a high-volume claim issue. A separate inquiry must be submitted for each additional claim in question for appropriate handling.”

Additional Resource 

• Visit the Electronic Claims page here on the Provider Resource Center.