How to Submit a Superbill to Highmark

Highmark BlueCross BlueShield is the dominant health insurer in Western Pennsylvania, Delaware, and West Virginia. Submitting an OON therapy superbill to Highmark is a well-supported process with strong regional mental health parity protections.

Overview: Highmark and Out-of-Network Mental Health Benefits

Highmark is a BCBS affiliate serving Western and Central Pennsylvania, Delaware, and West Virginia. Most Highmark commercial (employer-sponsored) and individual plans include OON mental health benefits under PPO plans, subject to an OON deductible and coinsurance. Pennsylvania has strong mental health parity enforcement, making it one of the better states for OON behavioral health reimbursement.

As a BCBS affiliate, Highmark's OON process is similar to other BCBS plans. You submit through the Highmark member portal at highmark.com, and the process is straightforward for PPO members. HMO members should verify network requirements before scheduling with an OON therapist. For more context on the general process, see our step-by-step superbill submission guide. For a full overview of Highmark coverage, visit our Highmark insurance guide.

Highmark processes OON behavioral health claims through its standard claims department. Most PPO plans do not require a referral for OON mental health services, but confirm your specific plan requirements before beginning treatment.

Step-by-Step Process for Submitting to Highmark

1. Get your superbill from your therapist. Request a superbill covering all sessions you want to submit. Highmark accepts batch submissions covering multiple dates of service on one claim.
2. Log in to your Highmark member account. Go to highmark.com and sign in with your Member Login credentials. Navigate to My Claims and select Submit a Claim. This is the fastest and most reliable method.
3. Complete the online claim form. Highmark will ask for provider name, dates of service, CPT codes, and amounts charged. Upload the superbill PDF as supporting documentation.
4. Alternative: mail your claim. Download the Highmark OON claim form from highmark.com and mail it with your superbill to the claims address on your ID card. Use certified mail for your records.
5. Note your confirmation number. After online submission, screenshot the confirmation page. After mailing, retain the certified mail receipt.

What to Include With Your Highmark Claim

Highmark requires the superbill to contain all required superbill fields. Specifically for Highmark, confirm your superbill includes:

• Provider full name, NPI (Type 1), and practice address
• Provider Tax ID (EIN or SSN) and professional license number
• Your name, date of birth, and Highmark member ID number
• Date(s) of service
• CPT procedure code (e.g., 90837 for 60-minute therapy) and description
• ICD-10 diagnosis code (e.g., F41.1 for generalized anxiety)
• Place of service code (11 for office; 10 for telehealth)
• Fee charged per session and amount you have already paid

Highmark's Processing Timeline

Highmark typically processes OON mental health claims within 30–45 days of receipt. Online submissions are received immediately; mailed claims add several days for postal transit. You will receive an Explanation of Benefits (EOB) in your Highmark portal before any payment is issued. Payment arrives by check or direct deposit if configured.

Highmark's filing deadline for most commercial plans is 180 days from the date of service. Submit promptly to avoid deadline issues.

Common Issues When Submitting to Highmark

• HMO plan limitations: Highmark HMO members generally cannot receive OON reimbursement for routine outpatient therapy. Verify your plan type (PPO vs. HMO) before submitting.
• Missing NPI: Highmark will reject claims without a valid provider NPI. Confirm your therapist's NPI is Type 1 (individual) and matches the NPI Registry.
• Delaware vs. Pennsylvania differences: Highmark operates slightly differently in Delaware than in Pennsylvania. If you are a Delaware member, verify the correct claims address on your ID card.
• Duplicate submission: Submitting online and by mail for the same dates of service will create a duplicate and delay processing. Choose one method.

Tips for a Smooth Highmark Claim

• Call Member Services before your first claim to verify OON deductible, coinsurance rate, and whether Highmark requires their own claim form in addition to the superbill.
• Use the Highmark member portal to track claim status. Claims appear within a few business days of online submission.
• Pennsylvania's mental health parity enforcement gives you strong appeal rights if your claim is denied. The Pennsylvania Insurance Department can assist if internal appeals fail.
• Submit monthly in batches rather than after every session to reduce administrative overhead and keep submission dates easy to track.

Superbilled makes it easy to generate Highmark-ready superbills with all required fields pre-filled. Once your therapist sends you the superbill, you can submit directly to Highmark through the highmark.com portal or by mail using the steps above.