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New Claims Edit: Patient Date of Birth Validation Coming January 2027
Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Aug 6, 2026
Summary
Beginning January 2027, Highmark will implement a new claims edit that validates patient date of birth (DOB) against their records during EDI submission. Claims with DOB mismatches will be rejected and must be corrected and resubmitted. This affects all professional and facility providers submitting claims to Highmark.
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What to do
by Dec 31, 2026 · 4 steps
01Billing team must implement verification procedures to ensure patient DOB on all EDI claims exactly matches Highmark's eligibility records in Availity Essentials before submission.
02Update billing system validation rules to cross-check DOB against Availity records.
03Train all billing staff on the new requirement.
04Designate a process for handling DOB mismatch rejections, including reconciliation with trading partners and claim resubmission.
If missed: Failure to verify DOB will result in claim rejections and processing delays.
Original notice
New Claims Edit: Patient Date of Birth Validation Coming January 2027
providers.highmark.com · Always check the source before changing claims.