medical-bill

HealthLink Payer Specific Business Rules and Limitations HealthLink claims are sent to payors in ANSI 837-5010A1 HIPAA claims format. Below we explain the use of business-specific fields for the benefit of payors receiving electronic claims from HealthLink networks. These guidelines should be read in conjunction with the ANSI X12 Implementation Guides. HealthLink transmissions are used in tandem with Read More →

HIPAA Business Scenarios

Bundling (Code Editing) Example (HealthLink) Correct coding (bundling) or code review / editing will be communicated in HealthLink’s outbound priced claims for professional claims (1500s) only, and for business blocks with code review / editing enabled (most business blocks). The following is an example to demonstrate how the service lines will be communicated for code Read More →

HIPAA Legislation

Overview of HIPAA Legislation by HealthLink The Health Insurance Portability and Accountability Act (HIPAA) of 1996 carries provisions for administrative simplification. This requires the Secretary of the Department of Health and Human Services (HHS) to adopt standards to support the electronic exchange of administrative and financial health care transactions primarily between health care providers and plans. Read More →

HIPAA Standard 276/277

HIPAA Standard 276/277 Claim Transactions (HealthNet) Requests for claims status for a single commercial, Medicare or state health programs member transaction may be submitted by registered participating providers on the Health Net provider website. Select the appropriate Verify claims link under Eligibility & Benefits to the left to get started. To request claims status information Read More →

EDI training

HIPAA Standard 270/271 Eligibility Transactions (HealthNet) Requests for eligibility status for a single commercial, Medicare or state health programs member transaction may be submitted by registered participating providers on the Health Net provider website. Select the appropriate Verify Eligibility link under Eligibility & Benefits to the left to get started. To request eligibility and obtain Read More →

Electronic Remittance Advice

Electronic Remittance Advice from Health Net Health Net has further streamlined our business processes to improve claims procedures. Providers can now register to receive Electronic Remittance Advices (ERA). These features streamline claim processing, reduce administrative work and improve provider satisfaction by reducing claims-related problems. ERA files give providers details regarding multiple claims. ERA improves providers’ Read More →

EFT

EDI Electronic Funds Transfer (EFT) Guides EFT automates the distribution of funds into providers’ accounts using Automated Clearinghouse (ACH) processing. EFT is the electronic mechanism used to instruct Depository Financial Institutions (DFIs) to move money from one account to another. Many formats are available for the actual data in the electronic message, and different formats apply Read More →

Submit claims

Submit claims through a clearinghouse: Get Started For successful EDI claim submission, you will need to use electronic reporting made available by your vendor and/or clearinghouse. Health Net returns claims acknowledgements to the clearinghouse with notifications of acceptance or rejection of individual claims. Providers can review these reports to check the status of their submission. Read More →

EDI webinar

  Requirements for Electronic Data Interchange Transmissions Electronic data interchange (EDI) is the exchange of business transactions in a standardized format from one computer to another. Health Net of California, Health Net Health Plan of Oregon, Inc and Health Net Life Insurance Company (Health Net) and providers use this technology to communicate claims, electronic remittance, claims Read More →

HIPAA claims training

EDI Claims Process At Medical Associates Health Plans and Health Choices Medical Associates Health Plans and Health Choices currently accept EDI transactions directly or from a clearinghouse. The payer ID’s are as follows: Change Healthcare: MAHC1 for Professional, Institutional and Dental RelayHealth: 2772 for Professional, 1928 for Institutional Medical Associates Health Plans also receives Medicare Cross-Over claims Read More →