Claim Mapping Requirements

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 Read More →

Professional Claims

HealthLink Professional Claims Mapping Guidelines For Participating Parties Correct claims mapping is the basis for the timely claims receiving and billing. All HealthLink business partners must comply with the guides given below. Billing Provider (2010AA) Occasionally, HealthLink will receive electronic claims with Billing Provider information but no Provider name and/or Provider ID for this, which is Read More →

HIPAA webinars

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 Read More →

HealthLink HIPAA Claims

HealthLink  HIPAA Claims Provider Guides Identifying the provider “par status” is important for proper administration of Open Access claims. The provider participating status can be obtained in the “Line Pricing/Repricing Information” segment (“HCP”). If a claim has been processed as non-participating, the following elements will be populated: Provider Taxonomy (Specialty) Codes The Provider Taxonomy Code Read More →