HealthLink HIPAA Guidelines For Institutional Claims
The instructions conform to all the requirements of any associated ASC X12 Implementation Guides and are in conformance with ASC X12’s Fair Use and Copyright statements. HealthLink companion guides must be used in conjunction with an associated ASC X12.
Institutional: Claims 837I (UB04s) Messages
In the 837I, the File Information (“K3”) segment occurs only at the claim level. Therefore, the pricing messages will be available at the Claim Level, Loop 2300.
Institutional: Subscriber Group Number and Group Name
In the 2000B loop, SBR04 (Group Name) is used only if SBR03 (Group Number) is blank. HealthLink will send the payor’s group number in SBR03 when available and leave SBR04 blank.
Institutional: Billing Provider (2010 AA)
Occasionally, HealthLink will receive electronic claims with Billing Provider information, but no Provider name and/or Provider ID for this, which is required under HIPAA.
Institutional: Pay-to-Provider
Occasionally, HealthLink will receive electronic claims with Pay-To Provider information, but no Provider name and/or Provider ID for this, which is required under HIPAA. If these fields are blank, HealthLink will populate the data as listed in section 3.2 Loop 2010AB.
Institutional: Subscriber Name
Occasionally, HealthLink will receive electronic claims with Subscriber information, but no Subscriber name and/or Subscriber ID for this, which is required under HIPAA. If these fields are blank, HealthLink will populate the data as listed in section 3.2 Loop 2010BA.
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