ANSI 837-5010 Claims (HIPAA Compliant Claims) Printer Friendly

HealthLink supports the ANSI 837 Version 5010 outbound EDI format for repriced claims sent to payors.

This applies to repriced claims for:

  • HealthLink PPO and Open Access
  • Other affiliated networks repriced by HealthLink (under special agreement)

Outbound repriced claims may be sent to payors via:

  • Emdeon (WebMD) clearinghouse
  • Direct connection - FTP w/PGP Encryption (if the business volume warrants a direct connection)

The Outbound EDI Companion Guide is available on the network websites: www.healthlink.com. The Companion Guide supplements HIPAA standards (found at www.wpc-edi.com ) with network specific rules, codes and details for our trading partners.

The Outbound EDI Companion Guide includes important details about:

  • Repricing Organization Identifiers for payor to code EOB remarks.
  • Open Access network product codes.
  • Code Review processes.
  • Adjusted claim processes.
  • Other PPO-specific field definitions.