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

By November 30, 2026: (1) Billing team must audit all pending claim adjustment requests and prioritize those approaching the 455-day threshold from original finalization date. (2) Update billing system calendar/tracking tools to flag claims nearing the 15-month deadline to prevent accidental late submissions. (3) Implement internal process to calculate claim finalization dates (not receipt dates) as the baseline for all timely filing determinations on Highmark claims. (4) Train billing staff that adjustment requests submitted after 455 calendar days will be denied regardless of circumstances. (5) Document the finalization date for all Highmark claims in the billing system for future reference. (6) Notify providers that the timely filing deadline is now 15 months from finalization, not from other reference dates. (7) Review Highmark Provider Manual 6.1 when updated on December 1, 2026 for any additional guidance. Failure to comply will result in automatic claim denials for adjustment requests exceeding 455 days.