Professional Claims Mapping Guidelines (HealthLink)
Correct claims mapping is the basis for the timely claims receiving and billing. All HealthLink business partners must comply with the guides given below.
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 3.1 Loop 2300.
Accident Date
If an Accident indicator is provided on the claim the assumption is that the condition being reported is Accident or Employment related. In these cases an Accident Date is required in the 837. If this field is blank, HealthLink will populate the data as listed in section 3.1 Loop 2300.
Admission/Discharge Date
If one of these dates is blank or invalid, HealthLink will populate the data as listed in section 3.1 Loop 2300.
Onset of Current Symptom, Illness
If the claim indicates there was a related illness or symptoms but does not have a valid date, HealthLink will populate the data as listed in section 3.1 Loop 2300.
Provider Signature on file and Assignments
If these fields are blank, HealthLink will populate the following data in the data elements listed.
Claim Frequency Code (Original and Adjustments)
If the claim is original to HealthLink, CLM05-3 in the 2300 loop will be populated with “1” (“Original claim”). If this is an adjustment to a claim previously processed by HealthLink, CLM05-3 will be populated with “7” (“Replacement claim”).
Patient Signature Source Code
If CLM09 (Release of Information Code) does not equal “N”, this code is required. If CLM10 is blank, HealthLink will populate the data as listed in section 3.1 Loop 2300.
HealthLink table with Loops sections.
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