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.