ANSI 837-4010 Claims (HIPAA Compliant Claims)

HealthLink supports the following outbound EDI format for repriced claims sent to payors:

• ANSI 837-4010A1 Implementation Guide with Addenda

This applies to repriced claims for:

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

Outbound repriced claims may be sent to payors via:

• Emdeon (WebMD) clearinghouse
• IPN 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 or www.ncppo.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.

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.