Provider FAQs

updated 11/8/13

Welcome to the Provider Resource Center FAQ Page


Please use the links below to help you find what you are looking for or to resolve a problem with the site.

If you can't find the information you are looking for please e-mail resourcecenter@highmark.com and one of our specialists will get back to you as soon as possible.


Using The Site
Answers to popular questions on how to navigate and interact with the site in the most effective way.

Electronic Data Interchange (EDI) & NaviNet
Information on direct, secure, and reliable access to health care services, quality claim inquiry and health information.

Links To Other Sites
Access to a variety of informative medical and health resources, including links to sites with general information and specific topics.


Electronic Data Interchange (EDI) & NaviNet


What is Electronic Data Interchange (EDI)?
EDI (Electronic Data Interchange) is the standard format for exchanging business data computer-to-computer. The greatest advantage to submitting information electronically is that it saves time and money by alleviating the need for paper forms, envelopes, stamps and by saving the related costs of time and labor.

Highmark's electronically connected customers use our applications and systems for direct, secure, and reliable access to health care services, quality claim inquiry and health information.

How do I begin using EDI to submit claims electronically?
If you wish to begin to submit claims electronically, you may contact the EDI Operations support line at 1-800-992-0246 to speak with a representative.
What is NaviNet®?
NaviNet® is a free, Internet-based application for providers to streamline data exchanges between their offices and Highmark. NaviNet® gives users real-time access to Highmark's membership, claims and provider and payment systems, making your job easier. NaviNet® seamlessly integrates all insurer-provider transactions into one system, such as inquiries on referrals/authorizations, eligibility, benefits, claims status, claims investigations, codes, and provider/facility searches. NaviNet can also be used to submit authorization requests, recredentialing applications, and provider information changes. NaviNet-enabled providers are expected to use this tool for all routine eligibility, benefits and claim status inquiries. For more information on NaviNet® and computer requirements for using NaviNet®, visit www.navinet.net/navinet-faq and select Are There Computer Requirements for Using NaviNet®?
How do I get NaviNet®?
Providers who participate with Highmark and are interested in more information on NaviNet® can visit the web site at www.navinet.net or call their Provider Relations Representative for more information.
How do I contact NaviNet® with technical issues?
Live NaviNet® Customer Care is available Monday - Friday, 8:00 a.m. - 11:00 p.m. and Saturday, 8:00 a.m. - 3:00 p.m. eastern standard time.

To speak to a NaviNet® Customer Care Representative directly, please call us during the hours listed above at 1-888-482-8057. For TDD/TTY services, please call 1-800-480-1419.

What is Highmark West Virginia's holiday schedule?
Highmark West Virginia Holiday Schedule

Links To Other Sites

The list of helpful links below offers you quick access to a variety of informative medical and health resources, including links to sites with general information and specific topics. Web sites for a number of medical and health organizations are also listed. Please be aware that the Internet sites available through these links, and the material that you may find there, are not under the control of Highmark. Therefore, we do not make any representation to you about these sites or the materials available there. Highmark is providing these links only as a convenience to you and is not endorsing or recommending any of these sites.

American Medical Association
A partnership of physicians and their professional associations dedicated to promoting the art and science of medicine.

Alternative & Complementary Medicine Center
Information on natural therapies, diet, fitness, diseases, professional courses and family health.

AMA - Health Insight
American Medical Association's site goal is to educate, provide scientifically accurate information, provide links to proven health care resources, and develop patient-doctor relationships.

American Academy of Child and Adolescent Psychiatry (AACAP)
Facts for parents and families and news about the AACAP.

American Institute of Nutrition
Research society for improving quality of life through nutrition science. Publishers of the Journal of Nutrition.

The Blonz Guide: Nutrition, Food & Health Resources
Comprehensive site covering nutrition, food science, food, fitness and health and a host of links. Research society for improving quality of life through nutrition science. Publishers of the Journal of Nutrition.

The Blue Cross Blue Shield Association
The association of all independent Blue Cross and Blue Shield Plans.

Complete Home Medical Guide
A searchable site with a large collection of health information organized by category.

CNN: Health
Searchable site with health-related news.

Delicious! Magazine Online
Delicious! Magazine Online has the latest information on health and healing, fitness & nutrition, healthy cooking, and a lot more.

Diet & Weight Loss/Fitness
Frequently asked questions about weight loss, diets and recipes. Links to expert documentation.

Doctor's Guide to the Internet
Medical news arranged by past seven days, past month and subject area. A collection of links to information on adoption, counseling, domestic violence, environmental health, parenting, and other areas.

FDA News and Publications
Press releases, talking papers, and publications from the U.S. Food and Drug Administration.

Harvard Health Publications
A collection of health articles, expert opinions, new products, back issues and more.

Healthfinder
A comprehensive range of information from health topics to medical dictionaries and the latest government news.

Healthtouch
Includes information on child and adolescent health, children's nutrition and dental care, and behavior, speech, hearing and learning.

Health World Online
Internet resource on wellness, natural health and alternative medicine information, products and services.

JAMA - Journal of American Medical Association
Web edition of the world's most widely read medical journal.

KidSource OnLine
In depth, timely education and healthcare information for parents. Has sections on newborns, toddlers, preschoolers, K-12, education, health, parenting, and more.

The Leapfrog Group
The Leapfrog Group is an initiative driven by organizations that buy health care who are working to initiate breakthrough improvements in the safety, quality and affordability of healthcare for Americans. It is a voluntary program aimed at mobilizing employer purchasing power to alert America's health industry that big leaps in health care safety, quality and customer value will be recognized and rewarded.

Lifelines Health Page
A collection of health, medicine and fitness resources in English and Spanish.

Medical Computing Today
Resources on clinical computing, medical education, medical informatics, the Internet, and more.

MediConf Next
MediConf Next lists the next 1000 future medical events taking place worldwide.

Medscape
Online Resource for Better Patient Care - Online resource for health professionals and consumers now offers free access to MEDLINE, which has over 500,000 registered users.

Medsite
A large searchable directory of medical and health information covering alternative medicine to health professions.

Men's Health Magazine
Articles, daily tips, quizzes, health gear, working out, and other areas.

National Institutes of Health
Health information, news and events, scientific resources, grants and contracts.

New England Journal of Medicine
A weekly journal reporting the results of important medical research worldwide.

New York Times: Your Health Daily
Timely, in-depth articles on a variety of health news topics, written for general readers and health professionals.

New York Times: Women's Health Resources
Guide to more than 100 Web sites offering detailed information on women's health issues.

NewsFile
A collection of links to health weekly magazines.

Nutrition Navigator
Reviewed nutrition sites for parents, kids, journalists, health professionals, and special dietary needs. Includes hot topics.

Physical Activity and Health
A Report of the Surgeon General. Fact sheets and summaries of this recent U.S. Department of Health and Human Services document available here for download.

United Way of America
Find support services for your patients through this link to local United Way Agencies.

World Health Organization
General information, press releases, reports, publications and other resources.

WWW Virtual Library: Biosciences: Medicine
A huge list of links to a wide range of medical and health web sites.


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