Highmark Incorrect Processing of Claims 

Unfortunately, Highmark ERA's received today have denials for physical medicine claims. We are seeing two types of denials; no authorization and patient not registered. 

We have decided to file Navinet investigations on ALL denied claims despite Highmark's assurance that this would be corrected on their end.

ACTION PLAN

Denials for authorization:  We are filing investigations with the authorization numbers or disputing the denial if an authorization was not needed.

Denials for Non Registration:  We are filing investigations claiming the Navinet system was not ready and therefore would not allow registration of the patient.  In addition, this is not consistent with their "soft implementation" plan.

Tracking: We have started a spreadsheet for each PT and Chiropractic  practice (billing clients only) with a list of investigations filed.  We plan to have the majority of the claims appealed today.  If you would like a list of the claims, please contact either Amy Parson or Vickie Mathews and they will email a password protected pdf.

PLEASE MAKE SURE THAT YOU ARE SENDING US THE PRINT OUT OF THE AUTHORIZATIONS YOU ARE OBTAINING.

As per previous notifications, we are not going to file investigations on the incorrect processing of PAID claims as Highmark requested that we  allow them the time to correct these claims and stated investigations would delay the process.  We are however also monitoring those and have taken the proactive steps to submit only the top highest paid services at the claim level.

Highmark is aware of the issues and has advised us that they are working as fast as possible to make the changes necessary.

Please let me know if you have any questions.

Danielle