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 →

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 →