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Sign Up to Conduct Electronic Transactions for Highmark West Virginia. Submitting claims may be one of the most common, time consuming, and complex administrative tasks that your office staff performs. However, using an electronic method, known as Electronic Data Interchange (EDI), can result in increased accuracy of claims, better tracking ability, and greater office efficiency and productivity.

In addition, you’ll also benefit from error reporting, which allows you to easily correct claims before submission. You will experience fewer payer rejections and administrative concerns, resulting in faster claim payments.

Register to do business with Highmark West Virginia via the Highmark Gateway

The Highmark Gateway, managed and maintained by Highmark, Inc. (Highmark), an independent company, provides EDI capabilities for Highmark West Virginia.

In order to conduct EDI business with any of the payers listed above, you will need to register as a trading partner with Highmark using the EDI Transaction Application online form ("Application").

When you fill out the Application, you will:

  • Provide contact information for your organization.
  • Have an authorized representative of your organization complete a Trading Partner Agreement with Highmark.
  • Supply NPI information for the providers on whose behalf you will conduct transactions.
Continue to Application

Trading Partner Agreements

Contained within the Application is a Trading Partner Agreement with Highmark that must be accepted before the Application can be submitted. The Trading Partner Agreement, among other things, sets forth the general terms and conditions under which the trading partner agrees to exchange information electronically.

Only authorized representatives of your organization may complete this Application. Please keep in mind that complete and accurate entering of your information will ensure that your Application is processed in a timely manner.

Timing considerations

Completing the Application should take 10 - 15 minutes.

Gathering trading partner information and provider data

Prior to beginning the Application, trading partners should be prepared with the following pieces of information:

  • Trading partner demographic information, including Tax ID Number.
  • Contact information for the trading partner team members identified above.
  • Software vendor information, including product name and support contact details. Trading partners who do their own EDI software development will also be required to submit this information.
  • NPIs for those providers on whose behalf you will be processing transactions.
  • The HIPAA 5010 transaction types you will be processing. Transactions currently supported include:

Standard transaction number

Transaction name

837I

Health care claim: Institutional

837P

Health care claim: Professional

835

Health care claim: Payment/Advice

999

Implementation Acknowledgment for Health Care Insurance

270/271

Health Care Eligibility Benefit Inquiry and Response

277CA*

Health Care Claim Acknowledgement


Authorization

Once you submit your Application, Highmark EDI Operations will review and validate it.

Upon completion of the authorization process, a Highmark West Virginia Trading Partner ID and password will be assigned to the trading partner.

The Highmark West Virginia Trading Partner ID and password allow access to a secure website where trading partners can upload and download their EDI transactions.