| We depend on
accurate eligibility information from payor partners. Timely
and accurate eligibility are essential 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identification or with outdated payor information. We rely
upon payors to provide accurate eligibility information to
enhance our claims routing processes.
New
Group Implementation - Payors should notify us 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 Group and Member Enrollment. Group changes and
terminations are presented in the same manner. Accurate payor
group files are necessary for optimum functioning of our claims
system. The group file is designed to point our processes
to the correct product type. Therefore, payors with multiple
products, such as medical and mental health need to notify
NCPPO 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. We offer various methods to our payor partners
for submitting membership information.
Frequency
of Eligibility Transmissions - Payors 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 - We prefer to receive files electronically
via:
Information
Required - Eligibility files must include all pertinent
membership information:
- Group names and the payor's
group numbers
- Network effective dates
- Subscriber/dependent information
(full name, subscriber social security number, address,
gender, birth date and relationship code)
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