Highmark Medicare Services is committed to providing the best customer support and satisfaction that we can.  For the Claims Processing department, this means processing your claims accurately and in conformance with the timeliness standards set forth by the Centers for Medicare and Medicaid Services (CMS).

While we would like to be able to finalize all clean claims within 30 days, it is not possible given the complexity of the process and the requirement that we operate within the funding levels provided by the CMS.  However, despite those constraints our timeliness percentages are consistently above CMS' standard of processing 95% of clean EMC claims within 30 days of receipt.  In fact, our monthly Claims Processing Timeliness (CPT) consistently averages in the 98 to 99 percent range.  For those times when a clean claim is not paid within 30 days of the receipt date, we are obligated to pay the CPT interest rate in effect at the time the claim finalizes. 

Not withstanding our overall success in processing claims within the CMS standard, we know there are times when certain claims locations experience processing backlogs.   Understandably, providers will have concerns and will seek an explanation and understanding of the situation.  If there is a known system problem, you will be advised during your call to the Customer Contact Center.  This will include a projected correction date if one is known.  On the other hand, if the issue is related to a processing backlog, the Customer Serivce Representative will not generally make a referral to the Claims area absent some other extenuating circumstances because the aged claims are being worked in age order (i.e. oldest first).