INSURER FILING GUIDE

Highmark Blue Cross Blue Shield (Pennsylvania)

Use this public information to prepare your packet, then confirm the route on the insurer's own page.

AT A GLANCE

Claim facts

Member form	MEMBER SUBMITTED HEALTH INSURANCE CLAIM FORM Number: CLM-139 Revision: R9-19 Open the insurer form
Portal upload	NO
Portal path	No upload path: public form says submit the claim and itemized statement to the address on the ID card
Mail address	PLAN-DEPENDENT: Submit the claim and itemized statement to the address provided on the back of your ID card.
Fax	Not published by the insurer
Attachments	Provider name and address on provider stationery; patient full name; each service date; service or supply or purchase type; charge
Deadline	Not published by the insurer for scoped commercial member claims
Outcome and status	My Highmark website or app shows claim status
Processing time	Not published by the insurer
Caveats	Commercial member form only; Pennsylvania CHIP and Medicare or Medicaid routes excluded; HMO or EPO out-of-network benefit depends on plan

STEP BY STEP

Read date: 10-09-2026

Confirm that the member's plan includes out-of-network outpatient therapy benefits. Highmark says the member website benefit booklet contains out-of-network restrictions and claim instructions. https://www.highmark.com/campaigns/annual-member-notice
Download the MEMBER SUBMITTED HEALTH INSURANCE CLAIM FORM, CLM-139 (R9-19). Complete every item and use one form per patient. https://www.highmark.com/content/dam/digital-marketing/en/highmark/highmarkdotcom/member/forms/medical-forms/Medical_Claim_Form.pdf
Attach an itemized provider statement with the provider name and address on provider stationery, patient full name, each service date, service or supply type, and charge. https://www.highmark.com/content/dam/digital-marketing/en/highmark/highmarkdotcom/member/forms/medical-forms/Medical_Claim_Form.pdf
Sign and date the certification. https://www.highmark.com/content/dam/digital-marketing/en/highmark/highmarkdotcom/member/forms/medical-forms/Medical_Claim_Form.pdf
NOT PUBLISHED: a member portal or app upload path. The public form directs the member only to the offline destination on the ID card, so portal_upload is NO. https://www.highmark.com/content/dam/digital-marketing/en/highmark/highmarkdotcom/member/forms/medical-forms/Medical_Claim_Form.pdf
Check claim status in My Highmark on the web or app. The exact member menu path and processing time are NOT PUBLISHED. https://www.highmark.com/employer/thought-leadership/employee-of-the-future/digital-health-experience

Portal upload: NO
Portal: My Highmark
Portal path: No upload path: public form says submit the claim and itemized statement to the address on the ID card
Mail address: PLAN-DEPENDENT: Submit the claim and itemized statement to the address provided on the back of your ID card.
Fax: NOT PUBLISHED
Attach: Provider name and address on provider stationery; patient full name; each service date; service or supply or purchase type; charge
File types: NOT APPLICABLE
File size limit: NOT APPLICABLE
Maximum files: NOT APPLICABLE
One file or separate files: NOT APPLICABLE
Confirmation: NOT APPLICABLE
Status check: My Highmark website or app shows claim status
Processing time: NOT PUBLISHED
Member deadline: NOT PUBLISHED for scoped commercial member claims
Deadline basis: YES: member contract controls
Mental health route: NOT PUBLISHED: no separate outpatient psychotherapy member filing route found

Confirm the address, fax number or portal path on the insurer's own claims page before you send; read on 10-09-2026.