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Ensure successful electronic claims submissions

July 1, 2014

As previously communicated, Highmark, Inc. (Highmark), an independent company, handles EDI transactions on behalf of IBC. Therefore, IBC trading partners and/or providers send and receive EDI transactions to and from the Highmark Gateway. IBC is in the process of migrating membership to a new operating platform. Until all of our business is on the new platform, trading partners will be receiving transactions from both the current IBC platform and the new platform via the Highmark Gateway. For proper claims processing, please ensure that your billing NPI is affiliated with the entity that submits your electronic claims (e.g., your clearinghouse vendor). If your billing NPI is not affiliated with the submitter, claims for migrated members will not be accepted for processing and will reject with both of the following status codes: 496: Submitter not approved for claim submissions for this entity; 562: Entity?s National Provider Identifier (NPI). If your claims are rejecting with these status codes, please contact your billing software vendor, clearinghouse vendor, or third-party billing service for instructions on how to submit an EDI enrollment request. Common reasons why your claims may be rejecting include, but are not limited to, the following: You have recently registered a new NPI with IBC, but you and your software vendor did not register your NPI with Highmark EDI. You have recently changed your billing software vendor, clearinghouse vendor, or third-party billing service, but your new vendor has not registered the NPI with Highmark EDI. If you know the trading partner assigned to the entity that submits your claims, please enroll by going to the EDI Trading Partner Business Center and completing the Provider Changes form. Please only enroll the NPI that identifies your billing group, not the individual NPIs for your practitioners. If you have any questions on how to enroll your NPI, please contact Highmark EDI Operations at 1-800-992-0246.

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