Update Claims Transactions
Requester Information
Your Name*:
Your Title*:
Your Company*:
Your Telephone Number*:
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Extension:
Your Email Address*:
Trading Partner Information
Trading Partner Number*:
Trading Partner Name*:
Trading Partner Type*:
Professional Provider
Clearinghouse-Professional
Institutional Provider (Facility)
Clearinghouse-Institutional
Billing Service - Professional
Software Vendor/Developer
Billing Service - Institutional
Professional Transactions
Claims (837)
ERA (835)
Inquiry(270, 276, 278)
Highmark BlueCross BlueShield West Virginia (54828)
Highmark Senior Solutions Company (15459)
Institutional Transactions
Claims (837)
ERA (835)
Inquiry(270, 276, 278)
Highmark BlueCross BlueShield West Virginia (54828)
Highmark Senior Solutions Company (15459)
Transmission Mode*
Internet/FTP
Internet Inquiry Transactions
Since you have selected both the Internet/FTP option along with a Highmark Inquiry Transaction(270, 276, 278), you are eligible to request Real-Time inquiry service. If your practice management software supports Highmark Real-Time transactions you may select one of the real-time options listed below.
Batch Transactions Only
Both Batch Transactions and Real-Time Transactions
If you are unsure of your software's Real-Time capabilities, please contact your software vendor.
Software Vendor Information
Name of Software*:
Vendor Name*:
Contact Name*:
Contact Telephone Number*:
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-
Contact Email Address:
Please check this box if you do your own EDI Software programming.
Additional Comments
Please use this space for additional description or instruction.
