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.