Learn More. The Peer-to-Peer request must be received by Maryland Amerigroup maryland prior authorization Care within two 2 business days of the initial notification of the denial. The intent of the Peer-to-Peer is to discuss the denial decision with the ordering clinician or attending physician. For specific details prioe authorization requirements, please refer to our Quick Reference Guide. Certain carefirst mental providers require prior authorization regardless of place of service.
EDI Electronic Data Interchange is the standard format for exchanging business data computer-to-computer. The greatest advantage to submitting information electronically is that it saves time and money by alleviating the need for paper forms, envelopes, stamps and by saving the related costs of time and labor.
Highmark's electronically connected customers use our applications and systems for direct, secure, and reliable access to health care services, quality claim inquiry and health information. If you wish to begin to submit claims electronically, you may contact the EDI Operations support line at to speak with a representative.
NaviNet is a free, Internet-based application for providers to streamline data exchanges between their offices and Highmark. NaviNet gives users real-time access to Highmark's membership, claims and provider and payment systems, making your job easier.
NaviNet can also be used to submit authorization requests, recredentialing applications, and provider information changes. NaviNet-enabled providers are expected to use this tool for all routine eligibility, benefits and claim status inquiries.
Providers who participate with Highmark and are interested in more information on NaviNet can visit the NaviNet Web site at www.
To speak to a NaviNet Customer Care Representative directly, please call during the hours listed above at Online contacts Provider Relations - provrel highmarkbcbsde. Highmark Delaware Holiday Schedule. Contact Us. If you have paid for our SolAce billing software please call our support line for our SolAce software information.
If you have purchased our SolAce software information please call us for testing requirements. If you use any other system you must call them to see if testing is required. Please check the box to accept their terms. Once the complete provider enrollment packet has been received, the documents will be processed.
Processing will take approximately three to five business days from the date of receipt After processing, a confirmation will be emailed to you as notification to begin filing claims electronically.
Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information. A Happy Friday message from a Satisfied User! I just transmitted my first batch of electronic claims through Claim Shuttle!
My question is, "Why didn't I find out about Claim Shuttle earlier?!? There simply is no comparison! Everything about it including your team is great! The ease of use and user-friendly environment is awesome. My work is truly cut in half by using Claim Shuttle. Please share my thanks with everyone involved. I am so happy to have found you! I just wanted to let you know how impressed I am with this service. Just as you promised, I was up and running within 20 minutes of our initial conversation.
I was really concerned that this transition was going to be difficult and costly, but I was wrong on both counts. Your product is everything you said it was. I am a very small company, and have actually now reduced my overhead by going with you guys! Thanks for your honesty and integrity! Wonderful team that is always willing to assist with issues or concerns. A most unexpected experience: Someone who knows and is helpful. A gold mine!! Excellent service and I never give anyone "Excellent" scores on surveys.
This time it was warranted. Thank you very much for the help. The rep and supervisor went out of their way to get the issue resolved. It was nice to have a direct contact with the same representative until the problem was resolved.
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