Highmark

Standard filing limit

365 days

Counted from

date of service

Appeal filing limit

180 days

Appeal window from

denial date

Notes

If timely filing is not established in the contract, claims must be received within 365 days of the last date of service in PA and WV (official provider manual; DE 180 days). Provider appeals: within 180 days from receipt of the denial notification in all service areas.

Provider portal

https://providers.highmark.com/ ↗ (opens in a new tab)Copy●Verified · August 2026Verified Aug 18, 2026 · Official web pageView source ↗ (opens in a new tab)

Highmark's Provider Resource Center — provider manual, news and policy updates.

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Authorization

Not yet published for this entry. Prior authorization requirements, channels and retro-authorization rules are published only when verified against a source.

Referrals

Not yet published for this entry. Referral requirements and retro-referral rules are published only when verified against a source.

Appeals

Not yet published for this entry. Appeal levels, filing channels and external-review options are published only when verified against a source.

Medical records

Not stated

Itemized bill

Not stated

Operative report

Not stated

Notes

Provider appeals may be submitted by telephone or in writing within 180 days of the denial notification (60 days for PA CHIP). Denial letters describe the right to submit written comments, documents, or other information relevant to the appeal; reconsideration reviews require the provider to share complete clinical information via telephone and fax. External IRO review of pre-payment coding disputes requires claim number, member name, date of service, reason for dispute and supporting documentation/records.

Common CARCs

29165096226

Common RARCs

MA119N29M119M79M51MA130N38N57N386M25

Top reasons

Timely filing (CARC 29) — Highmark documents a 365-day claim-filing window from the last date of service (PA/WV) or 180 days (DE) when the contract does not set one; corrected claims carry their own window (paired RARC MA119: provider-level adjustment for late claim filing).; Missing information / submission error (CARC 16) — Highmark's provider manual defines clean claims (no defect or impropriety, all required data present) and warns that paper claims with missing, invalid or unreadable information will be returned (paired RARCs: missing/incomplete/invalid NDC M119, charge M79, procedure M51, place of service N38).; Not medically necessary (CARC 50) — Highmark's provider manual documents that medical-necessity denials are rendered by a physician reviewer and may be appealed, with a peer-to-peer conversation option before appeal (paired RARCs N386 NCD-based decision, M25 level of service not substantiated, N29 missing documentation).; Non-covered charge / benefit denial (CARC 96) — Highmark documents benefit denials when the member's plan does not provide the benefit; the provider cannot appeal a benefit denial — the member can.; Information requested not provided / insufficient (CARC 226) — Highmark's provider manual defines clean claims as including all substantiating documentation, treats claims as unclean when medical records are requested, returns paper claims with missing, invalid or unreadable information, and (in WV) may deny when claim documentation fails to support a pre-certified service (paired RARCs: MA130 unprocessable as submitted, N38/N57/M119 missing-information remarks).