HealthLink depends on accurate eligibility information from its insurance company partners.
Timely and accurate eligibility are the essential ingredients for the efficient distribution
of claims after network repricing.
The regular transfer of accurate eligibility information results in significantly fewer
customer service issues. Providers may send claims without full payor identification or
with outdated payor information. HealthLink relies upon payors to provide accurate eligibility
information to enhance our claims routing processes.
New Group Implementation - Payors should notify
HealthLink regarding the implementation of a new client group in advance of the effective
date (whenever possible). Group information is submitted by fax 314-925-6638,
email to group@healthlink.com or mail to Enrollment.
Group changes and terminations are presented in the same manner. Accurate payor group files
are necessary for optimum functioning of our claims repricing system. The group file is
designed to point our processes to the correct product type. Therefore, payors with multiple
products, such as HMO, PPO and OA need to notify HealthLink in advance of effective dates
of product changes for specific groups.
Submitting Membership Information - Submission
of electronic membership (eligibility) information is also a crucial step in the network
operation. HealthLink offers various methods to its payor partners for submitting membership
information.
Frequency of Eligibility Transmissions - Insurance
carriers are required to submit full eligibility files on active subscribers and dependents
at least monthly (and sometimes more frequently), with recent terminations also shown in
order to update our files in an automated manner. Excel files are not acceptable transmission
methods.
Transfer Process - HealthLink prefers to receive files electronically
via:
Information Required - Eligibility files must include all
pertinent membership information:
- Group names and the payor's group numbers
- HealthLink effective dates
- Subscriber/dependent information (full name, subscriber social security number, address,
gender, birthdate and relationship code)
The change form used by our Information Technology department when a payor plans to make
changes in the file transmission method or format, is located on the last page of the specifications.
Electronic
Eligibility Format Specifications
Online
Eligibility Change Form
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