| 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identification or with outdated payor information.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 314-989-6638,
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:
- FTP
- E-mail to eligibility@healthlink.com
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.
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