There are financial benefits for utilizing electronic methods to receive and send claims. NCPPO/HealthLink assists providers to submit claims electronically using clearinghouses. We will submit claim and repricing data outbound to payors electronically, either directly or through a clearinghouse (such as Emdeon (WebMD)).

Inbound Claims (from Providers)
We continually work with our providers to increase the percentage of electronic claims received.

The following companies submit electronic claim submissions directly to HealthLink from HealthLink and NCPPO providers:

• Emdeon (WebMD)
• Gateway EDI
• SSI

Outbound Claims (to Payors) & Electronic Claim Formats

• 837-4010A1 Implementation Guide w/ Addenda
• Emdeon (WebMD) or Interactive Payer Network (IPN) clearinghouse options
• Direct Connection with Payor (given high claim volume)

Payors interested in receiving the ANSI 837-4010A1 format should contact the Payor Relations department to initiate the testing process. The ANSI 837-4010A1 format specifications can be downloaded from www.wpc-edi.com. Our outbound EDI Companion Guide can be obtained on www.ncppo.com or www.healthlink.com.

Optical Character Recognition (OCR) Technology
OCR technology is used to scan paper claims and place them into an electronic claim in the 837-4010A1 Implementation Guide with Addenda format. Scanned claims may be sent electronically with repriced amounts to our affiliated payors.

EDI Vendor Number
We require the use of our EDI vendor identification number for all claims submitted electronically. 90001 is the PPO number used for patient ID cards for NCPPO and/or HealthLink affiliated payors.

Route of Claims and Confirmations
Providers decide which clearinghouse best suits their needs. Clearinghouses furnish the providers with data requirements and the software necessary to communicate claim information. They may supply PC based software or other ways to submit files from the provider to their system. In turn, clearinghouses transmit the data to HealthLink/NCPPO electronically.

Clearinghouses usually send providers confirmation of receipt of the incoming electronic claims files and acknowledgement that they are relaying the claims to NCPPO/HealthLink. We send a receipt confirmation to the clearinghouse. The clearinghouse should relay NCPPO/HealthLink’s confirmation to the provider. Results of using other or additional, secondary clearinghouses may delay our receipt of the claim, and may impede the confirmation process. Some clearinghouses do not support a tracking mechanism to display the path a claim or confirmation has taken from the provider to and from NCPPO/HealthLink. Therefore, NCPPO/HealthLink cannot explain what interim clearinghouse(s) transmitted claims to us or if a provider will receive confirmation of claims received from the clearinghouse(s), in other words not for those with direct connection with us.