HealthLink’s HIPAA Additional Requirements
HealthLink strongly encourages Trading Partners to send HealthLink fully populated 997s for all received 837 transactions. The only naming convention requirement is the file should contain the text “997” within the file name. Acknowledgements will help ensure that the receiving party has accepted the claim files sent by HealthLink. For any non-standard acknowledgement files, HealthLink requests the trading partner to email these files to the Help Desk (edi-ops@HealthLink.com). HealthLink has developed a routine, daily file status process whereby payors are notified by phone in the event their claims files are not “picked up” timely. HealthLink will work with payors on problem files or rejected files as needed.
HealthLink 4010/5010 Implementation Strategy
In order to implement 5010 transactions, a trading partner testing cycle will be defined and executed for each transaction to be sent and received. On January 16, 2009, HHS published two final rules to adopt updated HIPAA standards; these rules are available at the Federal Register. In one rule, HHS is adopting X12 Version 5010 and NCPDP Version D.0 for HIPAA transactions. In the second final rule, HHS modifies the standard medical data code sets for coding diagnoses and inpatient hospital procedures by concurrently adopting the ICD-10-CM for diagnosis coding and the ICD-10-PCS) for inpatient hospital procedure coding. The Final rules can be found on the CMS website www.cms.gov under “Regulations and Guidance” and navigating to “Transaction and Code Sets Standards or by going directly to the Federal Register.
HealthLink uses the “HIPAA Toolkit” from Sybase as a self-certification tool for EDI transactions. Edifecs is used as a testing tool for outbound claims transactions for payors.
HealthLink requires that providers who wish to submit electronic claims to HealthLink do so via a clearinghouse. HealthLink currently receives claims directly from Emdeon, the SSI Group, Relay Health and Gateway EDI. Providers may utilize any clearinghouse they wish, but HealthLink ultimately receives the claims from these three designated clearinghouses.
Claims Submissions to Payors from HealthLink
Payors may receive their electronic claims from HealthLink in several ways. Payors may receive claims from the Emdeon, Interactive Payor Network (“IPN”), Interactive Planet, or Trizetto clearinghouses, which are our most popular connection types. HealthLink also supports a direct connection, where the payor receives repriced claims via FTP processes with encryption to protect PHI. This direct connection functionality is used primarily for largest volume trading partners.
How does HealthLink prefer to receive their eligibility from Payor’s?
HealthLink requires that payors wishing to receive electronic repriced claims submit electronic eligibility to HealthLink. The purpose of this is to ensure proper routing of claims as well as maintain a high level of automated repricing, thereby decreasing the amount of time it takes to get the claim repriced by HealthLink and forwarded to the payor of record. HealthLink uses eligibility to route claims to correct payors.
To learn more about EDI and become a certified EDI Professional, please visit our course schedule page.