ANSI 834 Enrollment Implementation Format

Submitting eligibility in HealthLink?s proprietary format continues to be acceptable under the HIPAA electronic standards.

However, for payors interested in transferring to an ANSI 834 enrollment format, HealthLink is able to accommodate this change.

The following specifications should be kept in mind when planning to convert to the ANSI 834 Enrollment format:

• The file should be submitted by File Transfer Protocol (FTP) with PGP encryption to HealthLink.
• The file frequency should be at least monthly (large business blocks are submitted bi-monthly or weekly, however).
• A full file format should be submitted.
• The HealthLink and/or NCPPO network effective and termination dates are submitted.
• The file should not contain dental members or other non-network participation data elements.
• Both subscriber SSN and payor?s policy numbers (privacy IDs) (in separate fields) should be submitted (unless other arrangements are made).
• The file should include recent terminations (preferably 90 days of termination records).

For payors interested in changing to the new format, please note:

• The current submission should not be discontinued until the testing is complete and approval granted to move to the new format.
• Programming must be accomplished prior to converting to another format.
• To indicate the intention to change to the new format, submit an eligibility format change form (in the Payor Administrative Manual) with a test file and eligibility layout documentation.

The ANSI 834 implementation format is a more specific version of the requirements for ANSI 834. This is the guideline used for our payor-PPO data transfers.

More information on ANSI 834 can be found on the website www.wpc-edi.com .

National Capital Preferred Provider Organization, Inc. ("NCPPO") is a Maryland corporation. HealthLink®, Inc., is an Illinois corporation. Both are organizers of independently contracted provider networks, which are made available by contract to a variety of payors of health benefits, including insurers, third party administrators or employers. Neither has control nor right of control over the professional, medical judgment of contracted providers, nor are they liable for any acts or failures to act, by contracted providers. Neither is an insurance company and neither has liability for benefits under benefit plans offered or administered by payors. HealthLink® is a registered trademark of HealthLink, Inc. Both companies are subsidiaries of WellPoint, Inc.