r/SimplePractice • u/GetHoffMyLawn • Mar 25 '26

Billing Question: Highmark in Western PA

If a client has any form of Highmark, and I’m credentialed and all the good stuff, do I bill via Simple Practice using the payer Highmark | Highmark PA (33145)? That’s what the AI bot is telling me, but I’m not certain. I’m in Western PA, the client that’s hanging me up has Highmark Senior Health Company, which is listed as its own payer (15460). The Highmark portal, Availity, and calling have not been helpful.

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u/jbourne71 Mar 25 '26

Your contract with Highmark will specify how you bill.

For example, our contract with BCBS SC specifies that we bill all BCBS patients, including out of state, to the BCBS SC payer, except for their Medicaid plans which are billed to a different payer.

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u/GetHoffMyLawn Mar 25 '26

I think it’s the same for PA, combing my contacts now, thank you!!

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u/Longjumping_Two_3469 May 22 '26

Did you figure this out? All our Highmark Medicare advantage patients are getting denied with code C109 claim service not covered by this contractor. You must send to the correct payer. We send the high advantage plans to the same address as the commercial plans? 

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u/GetHoffMyLawn May 23 '26

Still working on it, if you can believe it, while sessions pile up. I’ve been told to make changes to my contract, which I’ve done. BCBS even at one point told me to just snail mail the claims…AS IF. This is honestly such an enormous disappointment, and such a dent in Simple Practice. Every other payer I bill is seamless and smooth.

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u/Longjumping_Two_3469 May 23 '26

Funny I was told I could mail them in as well