Highmark Releases New Real-Time Connectivity Requirements

Effective in the December 2013 updates to our HIPAA Companion Guides, Highmark is updating its requirements for real-time inquiry transactions. In accordance with government regulations, Highmark will now accept to use of the CORE™ -compliant Web Services Description Language (WSDL) for all real-time inquiry transactions.

All HIPAA-covered entities are required by Federal law to adopt the Phase I & II CAQH CORE Eligibility & Claim Status Operating Rules by January 1, 2013. The goal of these Operating Rules is to create as much uniformity in the implementation of the electronic standards as possible. The rules are designed to facilitate successful interoperability between different entities by establishing a number of operating requirements go beyond the data content in the standard transactions to address how the standard transactions are implemented. Operating rules address transmission formats, response time, exception processing, error resolution and more.

As of January 2013, all new Highmark Trading Partners will be expected to use the CORE WSDL when submitting real-time inquiry transactions. All existing Trading Partners that submit real-time inquiry transactions are requested to implement the use of the new WSDL during 2013.

For more information about the CORE requirements you may go to: http://www.caqh.org/ORMandate_Eligibility.php

For questions about any Highmark EDI transactions, please contact EDI Operations at 1-800-992-0246.