HealthLink Professional Claim Mapping Requirements
Correct claims mapping is the basis for the timely claims receiving and billing. All HealthLink business partners must comply with the guides given below.
Referring/Ordering Physician Information
Occasionally, HealthLink will receive claims with Referring/Ordering 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 3.1 2310A/2420E/ 2420F. In NM109, HealthLink will populate the tax ID of the provider if the Provider Number is not provided. If the tax ID is not provided, then the element will be populated with “999999999”.
Purchased Service Provider Name
Occasionally, HealthLink will receive electronic claims with Purchased Service Provider 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 3.1 Loop 2420B.
Other Insurance 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 3.1 Loop 2320/2330A/2330B.
* “A” means the appropriate release of Information on File at Health Care Service Provider or a Utilization Review Organization.
Rendering Provider Code Qualifier and ID
Occasionally, HealthLink will receive electronic claims with “Rendering Provider” information but no Provider ID Number for this physician, which is required under HIPAA. If no Rendering Provider information is supplied, HealthLink will not populate this loop. If the provider number or qualifier is blank, HealthLink will populate the data as listed in section 3.1 Loop 2310B/ 2420A.
HealthLink table with Loops sections.
To learn more about HIPAA EDI and become a certified EDI Professional, please visit our course schedule page.