HealthLink Payer Specific Business Rules and Limitations
HealthLink claims are sent to payors in ANSI 837-5010A1 HIPAA claims format. Below we explain the use of business-specific fields for the benefit of payors receiving electronic claims from HealthLink networks. These guidelines should be read in conjunction with the ANSI X12 Implementation Guides. HealthLink transmissions are used in tandem with the ANSI X12N Implementation Guides, and are compliant with both the X12 syntax and those guidelines.
File Naming Conventions
HealthLink has established standard naming conventions for inbound and outbound ANSI transactions for automated transaction processing.
Outbound 837 Files
Outbound 837 files use the following naming convention: PGP Encrypted Files: HealthLink assigns a unique outbound file name to each encrypted outbound 837, such as 837i_20050601_1.pgp. The name assigned to the file has a structure described below.
HealthLink assigns a unique outbound file name to each decrypted outbound 837, such as 34719201-XXXX_837i_20050202_1.txt. The name assigned to the file has a structure described below. Identifying Products (HMO, PPO, Open Access) Several of the payors for which we reprice claims utilize HealthLink’s Open Access network products for some of their groups. The 837 format does not have a specific data element that can be used to identify Open Access indicators. The payor may utilize the following method to determine the status of the provider who rendered the service.
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