​We continue to share ti​ps to help providers and their administrative staff prepare for the upcoming self-service requirements that begin January 1, 2022. PEAR Practice Management (PM) offers transactions that can be used daily by your practice to provide efficient patient care. 

TIP #3: Obtaining claim details

Use the Claim Search transaction to obtain details specific to your claim:

• Check date
• Check number
• Service codes
• Paid amount
• Member responsibility

You can view claims with service dates up to three years back from the current date.

Review the Claim Search & Investigation user guide and eLearning course on the PEAR Help Center to learn more. 

TIP #4: Obtaining claim details for Out-of-Area and FEP members

Obtain claim-related details for a BlueCard^® out-of-area member using the BlueExchange^® Out of Area transaction. Select Claims Search from the options that appear.

For Federal Employee Program (FEP) members, CMS-1500 claims are sent directly to Highmark for processing. Therefore, you will need to use Highmark's NaviNet^® Open Plan Central or call their customer service team at 1-866-731-8080​ to obtain claim details.

Facility claims can be located through the Claim Search transaction by using the FEP member ID or claim ID.

Review the BlueExchange 101 or Claim Search & Investigation user guide and eLearning course on the PEAR Help Center to learn more.

NaviNet^® is a registered trademark of NantHealth, an independent company.