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Online Videos

Check out HealthLink’s videos for members to learn healthy lifestyle tips and tools.

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Wellness Newsletter

Published monthly, eHouseCall features health and wellness topics for the whole family along with advice from HealthLink’s Chief Medical Officer, Robert Sorrenti, MD.

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EOB Requirements Printer Friendly

Name and Address of Payor *
Toll Free Number for Payor *
Subscriber's Name/Address *
Subscriber's Identification Number *
Patient's Name *
Provider Name *
Provider Tax Identification Number (TIN) *
Provider's Participation Status (PPO, HMO)
Claim Date of Service *
Type of Service
Total Billed Charges *
Discount Amount
Allowed Amount *
Excluded Charges
Explanation of Excluded Charges (Code and Associated Key)
Amount Applied to Deductible
Co-Payment/Coinsurance Amount
Total Patient Responsibility *
Total Payment Made and To Whom *
Benefit Level Information (Annual Deductible/Amount Applied, Annual Out of Pocket/Amount Applied, Lifetime Maximums/Amount Applied)
ERISA Disclosure (if applicable)
Discount Remark - "Discount For HealthLink Participation" (Must Include Network Name) *

Required information on the list above is indicated by an asterisk (*).

HealthLink®, Inc., is an Illinois corporation. HealthLink, Inc. is an organizer of independently contracted provider networks, which it makes available by contract to a variety of payors of health benefits, including insurers, third party administrators or employers. HealthLink has no control or right of control over the professional, medical judgment of contracted providers, and is not liable for any acts or failures to act, by contracted providers. HealthLink, Inc. is not an insurance company and has no liability for benefits under benefit plans offered or administered by payors. HealthLink® is a registered trademark of HealthLink, Inc. and a separately incorporated and capitalized subsidiary of WellPoint, Inc. Any reference in the material to other organizations or companies, including their Internet sites, is not an endorsement or warranty of the services, information or products provided by those organizations or companies. Discount offerings made available by third-party vendors.