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HighmarkCommercial · Administrative · Reimbursement · PA, NY, DE, WVHigh impact

Claim Adjustment Requests Must Be Filed Within 15 Months of Original Claim Finalization Date

Act
by Nov 30, 2026
Effective date
Dec 1, 2026
Identified
Aug 27, 2026

Summary

Effective December 1, 2026, Highmark is implementing a new 15-month (455 calendar day) deadline for submitting claim adjustment requests, measured from the claim finalization date rather than receipt date. Claim adjustment requests submitted after this deadline will be automatically denied for untimely filing. This change applies to Commercial, Medicare Advantage, and Federal Employee Program (FEP) plans but excludes BlueCard Home.

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What to do

by Nov 30, 2026 · 7 steps
01Billing team must audit all pending claim adjustment requests and prioritize those approaching the 455-day threshold from original finalization date.
02Update billing system calendar/tracking tools to flag claims nearing the 15-month deadline to prevent accidental late submissions.
03Implement internal process to calculate claim finalization dates (not receipt dates) as the baseline for all timely filing determinations on Highmark claims.
04Train billing staff that adjustment requests submitted after 455 calendar days will be denied regardless of circumstances.
05Document the finalization date for all Highmark claims in the billing system for future reference.
06Notify providers that the timely filing deadline is now 15 months from finalization, not from other reference dates.
07Review Highmark Provider Manual 6.1 when updated on December 1, 2026 for any additional guidance.
If missed: Failure to comply will result in automatic claim denials for adjustment requests exceeding 455 days.

Original notice

Claim Adjustment Requests Must Be Filed Within 15 Months of Original Claim Finalization Date
providers.highmark.com · Always check the source before changing claims.
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Related changes

See all Highmark changes →
Updated: Corrected Claims Must Be Filed Within 15 Months of Original Claim Finalization DateHighEffective Sep 1, 2026 · ReimbursementBrowse every Highmark change in the policy list

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