Interactive Voice Response Unit (IVR) – Part B NJ/MD/DE/DCMA
1-877-235-8073

The Highmark Medicare Services IVR offers the provider community quick and easy access to Medicare related information.  This service is accessed via your telephone simply by calling the toll free provider customer service telephone number and selecting the option that you would like to use. You will have the ability to speak or touch tone your responses.  You will not hear the touch tone options during the initial prompts; you can either say the option or key the numeric value to the left of the option. For example if you would like to check claim status you can either say, “claim status” or press 2 on your telephone keypad.  The following options will be offered:

(1)       Eligibility
(2)       Claim Status
(3)       Checks and Earnings to Date
(4)       Pricing
(5)       Frequently requested Telephone Numbers      
(6)       Frequently requested Addresses
(7)       Medicare News
(8)       Appeal Rights
(9)       Fax On Demand

The Interactive Voice Response Unit (IVR) is easy to use. All you need is:

• The State in which the services were rendered
• Your NPI and PTAN
• Your patient’s Medicare name & Medicare Health Insurance Claim (HIC) number (nine numbers followed by a letter) for claim status and eligibility.
• The date of service (DOS) in question for claim status
• The patient’s birth date in MMDDYYYY format to obtain eligibility
• Your registered fax number when using the fax option.
• Telephone with handset or headset. The use of speakerphones and cell phones are not recommended.
• A quiet environment that you can speak clearly and naturally into your telephone.
   

Instructions for using the touchtone keypad to enter a HIC number

To enter a patient’s HIC number using touch tone, you must use the numbers on the telephone keypad that correspond to the number in the HIC number. 

To key the alpha suffix, press the *key to signal that you are entering a letter and press the key that includes the letter. Then press the corresponding number that denotes the position of the letter on that key. 

For example, to enter 123456789A, you would key 123456789  * 2 1. The * indicates that the next entry is the letter, the letter A appears on the number 2 key in the first position. 

To enter a suffix that has a letter followed by a number, key the 9 digit number, then the letter combination followed by the number. For example to enter 123456789C1, you would key 123456789*231. 

The exceptions to the keypad rule are:

Q=*11
S=*73
R= *72
Z=*12

Instructions for using the touchtone keypad to enter a patient name 

In order to enter the patients name using touch tone, you must use the numbers on the telephone keypad that correspond to the first six letters of the patient last name followed by the first initial. The letters Q and Z are exceptions and should be entered using the number 1. 

For example, John Williams would be entered as 9-4-5-5-4-2-5, this number represents the letters that correspond to Willia, J. 

Helpful Hints:

• Your NPI number should consist of 10 digits.

• You may know your PTAN as your PIN, provider or legacy number.

• You can say “Help” to obtain additional instructions.

• Your provider number should consist of 6 digits. Use preceding zeros if needed.

• Once you are comfortable with the call flow, you can speak and key without listening to the entire prompt.

• Saying “main menu” will always bring you to the beginning of the call flow.

• Saying “operator” will transfer your call to a Customer Services Representative.
   

USING THE MEDICARE INTERACTIVE VOICE RESPONSE UNIT (IVR) 

State Selection

You will be prompted for the state that the services were rendered in.

Say "Maryland" or Press 1.
Say "Delaware" or Press 2.
Say "DC Metro Area" or Press 3.
Say "New Jersey" or Press 4.
Say "Pennsylvania" or Press 5.

Main Menu

Say the option name or press the corresponding number

(1)       Eligibility
(2)       Claim Status
(3)       Checks and Earnings to Date
(4)       Pricing
(5)       Frequently requested Telephone Numbers
(6)       Frequently requested Addresses
(7)       Medicare News
(8)       Appeal Rights
(9)       Fax On Demand

(1) Eligibility

Say “Eligibility” or press 1.

Say or enter your NPI number.

Say or enter your PTAN number.

Say or enter the patient’s Medicare number.

You can use the touch tone keypad for the HIC

(Refer to the instructions on the front)

Say or enter the patient’s name as it appears on their Medicare card.

You can use the touch tone keypad for the name by selecting the key that corresponds to the first six letters of the patient’s last name, followed by the first initial.

Say or enter the patient’s date of birth in either MMDDYYYY format or you can say the month, day and year. For example June 1, 1950 or 06011950

Say or enter the date of service in MMDDYYYY format so that MSP and HMO files can be verified.

Please note: You can not check future dates for entitlement as the information may change from the time you verified the information until the future date.

After you receive your information you can

• Say “Repeat that”
• Say “Change Date” to enter a different date of service for the same HIC
• Enter another HIC when you hear the prompt “Another Medicare number”
• Say Main Menu 

You will receive the following eligibility information:

• Part A and B effective dates
• Date of Death          
• Part B current and prior deductible
• PT/OT amounts
• Medicare Primary or Secondary based on the dates of service entered and reason
• Medicare Advantage information
• Home Health Information
   

(2) Claim Status

Say “Claim Status” or press 2.

Say or enter your NPI number. 

Say or enter your PTAN number.

The first thing you will hear are your pending approved to pay and finalized claim counts. 

Say or enter the patient’s Health Insurance Number (HIC) and patient’s name as it appears on their Medicare card. You do not have to wait to hear all of the claim count information; you can interrupt by saying the HIC number or keying it.  

You can use the touch tone keypad to enter the name and number. Refer to the instructions for using the touch tone keypad.

Say or enter the date of service in MMDDYYYY format or you can say the month, day and year. For example June 1, 1950 or 06011950.

After you receive your information you can

Say “repeat that” or press 1

Say “next claim” or press 2

Say “previous claim” or press 3

Say “claim details” or press 4

Say “additional information” for PTANs associated with this NPI or press 5

Say “change the date” or press 6

Say “change the Medicare number” or press 7

Say “change he PTAN” or press 8

Say "change NPI" or press 9

Say “main menu” 

You will receive the following claim information:

Claim Level Details

• Number of claims for the Date of Service (DOS)
• Status of the claim - pending, processed, denied or rejected
• Amount submitted
• Allowed amount
• Amount applied to the deductible
• Amount paid
• Paid date
• Check number
• Date of development if applicable and to whom

Line Level Details

• Claim Control Number
• Number of line items
• Date of Service (DOS)
• Amount submitted
• Allowed amount
• Procedure Code and modifier
• Diagnosis code
• Reason for denial if one of the top 100
   

(3) Checks and Earnings-To-Date

Say “checks and earnings to date” or press 3.

Say or enter your NPI number.

Say or enter your PTAN number.

Say “checks” (press 1) or Say “earnings-to-date” (press 2).

If you select Checks, you can search by

            Check number or press 1

                        Say or enter the 9 digit check number

                        Press * for help

            After you receive this information you can:

                        Say “repeat that” or press 1

                        Say “change the check number” or press 2

                        Say “Additional Information” for associated PTANs or press 3

                        Say “change the PTAN” or press 4

                        Say “change the NPI” or press 5

                        Say “main menu”

            Check Status or press 2

Say “outstanding” or press 1

Say “paid” or press 2

Say “stopped” or press 3

Say “voided” or press 4

            Range of Dates or press 3

Say the starting date and ending dates in MMDDYYYY format

After you receive the check information by status or range of dates you can:

                        Say “repeat that” or press 1

                        Say “next check” or press 2

                        Say “previous check” or press 3

                        Say “change the date” or press 4

                        Say “change the status” or press 5

                        Say “Additional Information” for associated PTANs or press 6

                        Say “change the PTAN” or press 7

                        Say “change the NPI” or press 8

                        Say “main menu”

If you select Earnings-To-Date, you will hear your

            Current approved to pay amount

            Month-to-date earnings

            Year-to date earnings

After you receive this information you can

            Say “repeat that” or press 1

            Say "change the PTAN" or press 2

            Enter another provider number 

You will receive the following check information:

• Check number
• Check issue date
• Check amount
• Cash date
• Check status if not cashed– outstanding, cancelled or voided 

(4) Pricing

Say “Pricing” or press 4.

Say or enter your NPI number.

Say or enter your PTAN.

Say or enter the procedure code and modifier (TC or 26) or say no modifier

Say or enter the date of service

Say or enter the locality of your office – 01 or 99 (See Note below)

After you receive the pricing information you can

            Say “repeat that” or press 1

            Say “change the procedure code” or press 2

            Say “change the PTAN” or press 3

            Say "change the NPI" or press 4

            Say “main menu” 

Localities for the IVR Pricing Option - NJ and MD

NJ Offices enter 99, except for Bergen, Essex, Hudson, Hunterdon, Middlesex, Mossir, Passaic, Somerset, Sussex, Union and Warren enter locality 01.

MD Offices enter 99, except for Baltimore enter locality 01.

(5) Frequently requested Telephone Numbers

Say “Phone Numbers” or press 5 for Frequently Requested Telephone Numbers.

When you hear the prompt for the telephone number you want, just say the name. For example if you are looking for the telephone number for EDI, just say “EDI” or press 3.

• Telephone Appeals or press 1
• Provider Enrollment or press 2
• EDI or press 3                      
• Beneficiary Services or press 4
• Railroad Medicare or press 5 

(6) Frequently requested Addresses

Say “Addresses” or press 6 for Frequently Requested Addresses

When you hear the prompt for the address you want, just say the name. For example if you are looking for the address for claim submissions, just say “claim submissions” or press 4.

• General Inquiries or press 1
• Provider Enrollment or press 2
• Freedom of Information or press 3
• Claim Submissions or press 4
• Highmark Medicare Services Website or press 5 

(7) Medicare News    

Say “Medicare news” or press 7

This option will contain information that we feel is important to the provider community and will change quarterly. 

(8) Appeal Rights

Say “appeal rights” or press 8

This option will explain the three levels of appeal that are available to the provider and beneficiary community. 

(9) Fax On Demand

Say “fax on demand” or press 9

Say or enter your NPI number.

Say or enter your PTAN number.

            Say Office or press 1

            Say Billing or press 2

            Say Other or press 3

                        Enter your 10 digit registered “Other” Fax number 

After you enter this information, select from the following:

            Say Provider Summary or press 1

            Say Pending Claims or press 2

            Say Finalized Claims or press 3

You will be prompted to enter the beginning and ending date range.

If the date span accumulates more than 20 pages of claims, you will be prompted to enter a new range. This is to ensure we do not overload your fax machine.

After you request your fax, you can

           Say “repeat that” or press 1

           Say “another fax” for the same PTAN or press 2

           Say “change the PTAN” or press 3

           Say “change the NPI” or press 4

           Say Main Menu 

Security for fax options 1- 4

Press 1 to have your documents sent to the number we have on file for your home office.

Press 2 to have your documents sent to the number we have on file for your billing office.

Press 3 to enter another fax number you previously registered with us.

Fax Authorization

In order to use the fax option, you must register the fax numbers that are authorized to receive faxes. This will ensure the financial information that is being sent is secure and restricts the faxing of your information to only the numbers you have provided us. If this information changes, it is your responsibility to notify us. 

The fax authorization form is located here (PDF format). You must complete this form prior to using this option.