Resources
This section contains important billing and claims submission guidelines and other reference information to help you successfully conduct standard electronic transactions with Highmark West Virginia via the Highmark Gateway.
Information about system maintenance and Electronic Data Interchange (EDI) changes can be found on our News page.
Resources and Reference Documents
v5010 Provider Companion Guide
This document addresses how trading partners conduct professional claim, institutional claim, claim acknowledgment, and claim payment advice HIPAA standard electronic transactions with Highmark West Virginia in the 5010 version. This document supplements the HIPAA-mandated v5010 ASC X12 Implementation Guides and addenda with clarifications and payer-specific usage and content requirements.
Trading Partner Agreement: Providers
Trading partners who are professional or institutional providers will need to execute a Trading Partner Agreement with Highmark in order to conduct EDI business with Highmark West Virginia via the Highmark Gateway.
Trading Partner Agreement: Clearinghouses and Vendors
Trading partners who are clearinghouses, billing services, or software vendors will need to execute a Trading Partner Agreement with Highmark in order to conduct EDI business with Highmark West Virginia via the Highmark Gateway.
Secure Transport SFTP Specifications
This document addresses the Internet file transfer options available for Secure Transport, Highmark's secure file transfer protocol (SFTP) server. Trading partners must meet these technical requirements in order to connect to the Highmark Gateway.
v5010 ASC X12 Implementation Guides
This section provides a link to where trading partners may acquire the HIPAA-mandated v5010 ASC X12 Implementation Guides and their related standardized code lists.
Real-Time Inquiry Connectivity Specifications
This document addresses the technical requirements for conducting inquiry transactions with Highmark in real-time mode.
Real-Time Claims Connectivity Specifications
This document addresses the technical requirements for conducting claim adjudication and claim estimation transactions with Highmark in real-time mode.
Trading Partners may submit additional documentation for claims to Highmark West Virginia using this cover sheet.
