1. NaviNet Claim Status Inquiry

The Claim Status Inquiry function lets you view real-time, detailed claims information for any member, whether claims were submitted electronically or on paper. You can track the status of a claim from the start of the adjudication process until the time of payment, or you can look up claims dating back seven years.

To check claim status, log in to NaviNet , select Claim Status Inquiry under Workflows for this Plan to access the Search screen and enter the patient and claim details.

2. 276/277 – Health Care Claim Status Request and Response Transaction

The HIPAA-mandated 276/277 electronic claim status request and response are a paired transaction set — the 276 transaction is used by providers to request the status of a claim(s) and the 277 transaction is how payers respond with information regarding the specified claim(s).

The payer’s response indicates where the claim is in the adjudication process (e.g., pending or finalized). If finalized, detailed information is provided on whether the claim is paid or denied, and if denied or rejected, the reason is included.

Highmark will accept and return 276/277 transactions in Version 5010 format only. These transactions will only be accepted and returned via real-time; trading partners are not able to submit electronic inquiry transactions in a batch mode.

Information about the 276/277 transactions can be found in the EDI Guide, available on the Electronic Data Interchange (EDI) website. To access the website from the Provider Resource Center, select CLAIMS, PAYMENT & REIMBURSEMENT, and then Electronic Data Interchange (EDI) Services.

3. BlueExchange – For BlueCard Claims

You actually have two options to check the status on out-of-area claims. You can use the Claim Status Inquiry function in NaviNet or you can access BlueExchange through NaviNet.

• NaviNet’s Claim Status Inquiry is not just for local claims; it can also be used to find the latest status on out-of-area claims. To view out-of-area claims electronically, you must include the prefix when entering the member’s identification number.
• BlueExchange through NaviNet enables you to obtain BlueCard claim status. The Claim Status Inquiry Option in BlueExchange even allows you to search for the status of out-of-area Medicare cross-over claims or those filed directly to the member’s Home Plan.

Additional Resources

These electronic methods for making claim status inquiries are easy to use and deliver status updates quickly, saving you and your team valuable time. For more information regarding claims inquiries, see the Highmark Provider Manual:

• Chapter 2 – Product Information, Unit 6: The BlueCard Program
• Chapter 6 – Billing & Payment, Unit 1: General Claim Submission Guidelines