We continue to share tips 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.