Provider Frequently Asked Questions and Answers

1) What is Electronic Data Interchange (EDI)?

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. You can get more information by clicking on the Electronic Data Interchange (EDI) Services link in the Claims, Payment & Reimbursement category on the left menu.

2) How do I begin using EDI to submit claims electronically?

If you wish to begin to submit claims electronically, you may contact the EDI Operations support line at 1-800-992-0246 to speak with a representative. You can get more information by clicking on the Electronic Data Interchange (EDI) Services link in the Claims, Payment & Reimbursement category on the left menu.

3) What is NaviNet^®?

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 seamlessly integrates all insurer-provider transactions into one system, such as inquiries on referrals/authorizations, eligibility, benefits, claims status, claims investigations, codes, and provider/facility searches. 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.

4) How do I get NaviNet?

Providers who participate with Highmark and are interested in more information on NaviNet can visit the NaviNet Web site at www.navinet.net.

5) How do I contact NaviNet with technical issues?

Live NaviNet Customer Care is available Monday - Friday, 8:00 a.m. - 11:00 p.m. and Saturday, 8:00 a.m. - 3:00 p.m. eastern standard time.

To speak to a NaviNet Customer Care Representative directly, please call during the hours listed above at 1-888-482-8057. For TDD/TTY services, please call 1-800-480-1419.

6) Can you explain the credentialing process?

Please reference the: HIGHMARK PROVIDER MANUAL: Chapter 3, Unit 2: Professional Provider Credentialing for additional information related to the credentialing process and requirements.

7) What is Highmark's Holiday Schedule?

Highmark's Holiday Schedule