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Identifying A Network (Repricing Organization Identifiers HealthLink)

In addition to repricing claims for the HealthLink network; HealthLink utilizes the HCP04 data element, Repricing Organization Identifier, at both the claim level (2400 loop) and line level (2300 loop) to indicate to the payor which network repriced the claim. This is valid on both Institutional (837I) and professional (837P) claim types.

For payors utilizing National Care Network (NCN) as an out-of-network cost containment program, the following table of repricing organization identifiers and EOB remark codes need to be set-up and recognized by the payor. NCN provider discounts will not be honored unless EOB’s have proper remark descriptions. NCN access/use requires a special HealthLink contract and special rate established. Payors not using NCN services should not program their system for these special repricing organization identifiers (range from 900010059 to 900010062, 900010064, 900010065, 900010124, 900010125, 900010141, 900010148 to 900010152, 900010300 to 900010324 and 900010326) unless using NCN services.

Repricing Messages HealthLink communicates various repricing messages for payors. HealthLink utilizes its proprietary messages that are currently in use for manual claims. The 837 format has a Claim Level and Claim Line Level File Information segment (“K3”) which can be used for communicating such messages. The table below shows how HealthLink communicates these messages in the K3 Segment. The K3 segment can repeat up to 10 times. The first occurrence of the K3 segment will contain the adjustment reason code and description. The error codes and descriptions will start in the 2nd occurrence of the K3 segment.

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If the claim has not been adjusted, but an error code exists, the first instance of the K3 segment will contain “NA”.

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