Medicare AdvantageAdministrativeHigh impact
SEPA: Self-Service Tools Required for Claim Status and Investigation – Starting Nov. 1
Highmark·PA·Reimbursement
Effective date
Nov 1, 2026
We identified it
Aug 25, 2026
Summary
Effective Nov. 1, 2026, Highmark will require all providers in the Southeastern Pennsylvania (SEPA) service area to use self-service tools (Availity Essentials, Provider Chat, IVR) for claim status inquiries and claim investigations. The Highmark Provider Service Center will no longer handle these requests and will direct providers to self-service options instead.
Action Required
By October 31, 2026: (1) Billing team must ensure all staff have active Availity Essentials access and are trained on the self-service tools for claim status and claim investigation submission. (2) Update internal workflows and procedures to route all claim status and claim investigation inquiries to Availity Essentials instead of calling the Highmark Provider Service Center. (3) Document the new process in billing procedures and communicate to all front-desk and billing staff. (4) Test claim investigation submission in Availity prior to the effective date. Failure to transition to self-service tools may result in delayed responses and inability to obtain claim information from Highmark representatives.