Highmark Blue Cross Blue Shield of West Virginia: Billing Guide
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Highmark is the Blue Cross Blue Shield licensee for all of West Virginia, and its professional payer ID there is 54828.
Checked 10/1/26.
Across Highmark's states: Highmark Health is the parent company, and Highmark's entities are independent licensees of the Blue Cross Blue Shield Association (Highmark manual, chapter 1). Portal: Availity Essentials (support 800-282-4548). EDI help desk 800-992-0246, weekdays 8:00 a.m. to 4:30 p.m. Eastern. Paper claims must be on an original red CMS-1500. Credentialing: CAQH ProView first, then the Highmark Initial Credentialing Request Form (credentialing). Provider appeals: 180 days from the initial denial, by phone or in writing (chapter 5, unit 5). Timely filing, if your contract is silent: 365 days from the last date of service (PA CHIP: 180 days). Corrected claims: within 15 months of the original claim's finalization, effective 9/1/2026 (general claim guidelines). Behavioral health is in-house (Highmark Behavioral Health Services). As of March 1, 2026, outpatient prior authorization applies to ABA, intensive outpatient, partial hospitalization and TMS. The page does not list routine outpatient psychotherapy or medication management. FEP and Medicare are excluded (behavioral health unit). Telehealth: Reimbursement Policy RP-046 requires place of service 02 or 10 plus modifiers (telemedicine unit); read RP-046 for modifiers.
Quick facts
| Professional (837P) payer ID | 54828 (Medicare Advantage PPO: 15459) |
|---|---|
| Behavioral health phone | 800-344-5245. Fax 877-650-6112 |
| Provider appeals | Pre-service: Appeals Committee, PO Box 535095, Pittsburgh, PA 15253-5095. Post-service: Medical Review, PO Box 1948, Parkersburg, WV 26102 |
| Paper claims | PO Box 7026, Wheeling, WV 26003 (listed in the manual's "Claims Filing" section) |
| State regulator | West Virginia Offices of the Insurance Commissioner |
Source: Highmark manual, chapter 6, unit 2, matched to the March 2026 EDI companion guide.
Frequently asked questions
What is the Highmark payer ID in West Virginia?
54828 for professional (837P) claims. Highmark's Medicare Advantage PPO uses 15459.
How long do I have to appeal a Highmark denial?
Provider appeals are due within 180 days of the initial denial, by phone or in writing.
Who manages behavioral health for Highmark in West Virginia?
Highmark manages it in-house through Highmark Behavioral Health Services. The behavioral health phone is 800-344-5245.
How MCM South helps with Highmark West Virginia
MCM South bills Blue plans for psychotherapists and psychiatrists in the states we serve. We verify benefits, submit claims electronically, follow up on denials and appeals, and handle credentialing. Get a free quote. If a Highmark West Virginia claim is denied or credentialing stalls, we follow up for you.
MCM South currently serves practices in GA, MA, CT, TX, FL, NY, CO, TN, NC and IL, and has worked in all 50 states. If your state is not on that list, ask us. This page is operational guidance for billing, not legal advice. For real financial or legal exposure, talk to your attorney or compliance officer.
Related: Blue Cross by State · How Blue Cross Blue Shield Works · Billing Terms Glossary · CPT and E/M Code Guide · Who We Serve.
This is the MCM South guide to Highmark West Virginia for therapists and psychiatrists: where claims go, how appeals work, and what to check first.
Want a billing team that handles this for you? MCM South bills for psychotherapists and psychiatrists. Get a free quote.