HealthLink Guidelines For HIPAA Institutional Claims
Find below the HealthLink requirements for Institutional Claims.
Institutional: Related Causes Code
If an Accident Date is provided on the claim the assumption is that the condition being reported is Accident or Employment related. In these cases a Related-Causes Code is required in the 837. If this field is blank, HealthLink will populate the data as listed in section 3.2 Loop 2300 A.
Institutional: Attending Physician Name (2310 A)
Occasionally, HealthLink will receive electronic claims with Attending Physician information, but no Provider name and/or Provider ID for this physician, which is required under HIPAA. If these fields are blank, HealthLink will populate the data as listed in section 3.2 Loop 2310.
Institutional: Operating Physician Name (2310 B)
Occasionally, HealthLink will receive electronic claims with Operating Physician information, but no Provider name and/or Provider ID for this physician, which is required under HIPAA. If these fields are blank, HealthLink will populate the data as listed in section 3.2 Loop 2310 B.
Institutional: Other Operating Physician Name (2310C)
Occasionally, HealthLink will receive electronic claims with Other Physician information, but no Provider name, Provider Type, ID, and/or taxonomy code for this physician, which is required under HIPAA. If these fields are blank, HealthLink will populate the data as listed in section 3.2 Loop 2310C.
Institutional: Other Insurance Coverage Information
If the claim contains other insurance information or indicates there is other coverage, then additional other insurance coverage information is required. Additionally, Other Subscriber Demographic information that is required may not be present. If the other insurance coverage information fields are blank, HealthLink will populate the data as listed in section 3.2 Loop 2320/2330A.
Institutional: Revenue Codes
Occasionally, HealthLink will receive claims with a 3-digit revenue code. In these cases, HealthLink will convert these to the required 4-digit revenue code in SV201.
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