Important Reminder: Include Rendering Provider Information on All Claims

Highmark has seen an increase in claims submitted with missing or incorrect rendering provider information. We want to remind you that all claims must contain the correct rendering/servicing provider information, including:

  • National Provider Identifier (NPI)
  • Provider Taxonomy Code correlating to the contracted specialty when more than one rendering/performing provider’s NPI is associated with a Highmark-assigned provider number to enable accurate application of the provider’s contractual business arrangements with Highmark 

Failing to provide the correct rendering provider information can result in your claims being delayed or denied unnecessarily.

You can verify your practice information or make changes via the Provider File Management functionality on NaviNet. This function can be used to update the practice information such as contact information, practitioners affiliated with a location, office hours, age range the practice serves, etc. For more information, see the Highmark Provider Manual, Section 3.3, Reporting Changes in Your Practice.

Please note that any claim – including $0 CPTII codes entered via NaviNet 1500 – submitted on or after May 1, 2019 that did not list a performing provider will be evaluated for the E6343 rejection. Please ensure that you have addressed/corrected any E6343 rejected claims with the necessary rendering (for billable claims)/attributed (for CPTII codes only) provider information.

How to Enter Rendering/Attributed Provider on NaviNet 1500 Claim Submissions

When submitting NaviNet 1500 claim submissions, providers must select the provider who performed the service, or a physician within the attributed practice, when applicable. 

As shown below, under Rendering/Servicing Provider, click the arrow to open the drop down menu which displays all providers within the billing provider number. You will need to select the rendering/attributed provider for any CPTII codes submitted.

NOTE: If the rendering provider is not listed in the drop down, providers may submit the CPTII code based on a provider within the attributed practice.

 

If you need additional information about submitting claims – including $0 claims with CPTII codes via NaviNet 1500 claim submissions, see the Highmark Provider Manual, Section 6.4, Professional (1500/837P) Reporting Tips, or contact your Provider Account Liaison.

print this story
Provider News, Issue 1, 2020   |   © 2020 Highmark Blue Cross Blue Shield Delaware

 

esubscribe