Companion Guide Version Number: V 1.1 TDC.11.001 June 02,
Companion Guide Version Number: V 1.1 – TDC.11.001June 02, 2020
HealthLink 837 Companion GuideThis template is Copyright 2010 by The Workgroup for Electronic Data Interchange (WEDI)and the Data Interchange Standards Association (DISA), on behalf of the Accredited StandardsCommittee (ASC) X12. All rights reserved. It may be freely redistributed in its entirety providedthat this copyright notice is not removed. It may not be sold for profit or used in commercialdocuments without the written permission of the copyright holder. This document is provided “asis” without any express or implied warranty. Note that the copyright on the underlying ASC X12Standards is held by DISA on behalf of ASC X12.2011 Companion Guide copyright by HealthLinkPrefaceCompanion Guides (CG) may contain two types of data, instructions for electronic communications withthe publishing entity (Communications/Connectivity Instructions) and supplemental information forcreating transactions for the publishing entity while ensuring compliance with the associated ASC X12 IG(Transaction Instructions). Either the Communications/Connectivity component or the TransactionInstruction component must be included in every CG. The components may be published as separatedocuments or as a single document.The Communications/Connectivity component is included in the CG when the publishing entity wants toconvey the information needed to commence and maintain communication exchange.The Transaction Instruction component is included in the CG when the publishing entity wants to clarifythe IG instructions for submission of specific electronic transactions. The Transaction Instructioncomponent content is limited by ASCX12’s copyrights and Fair Use statement.June 2020 005010ii
HealthLink 837 Companion GuideTable of ContentsCopyright Notice and Disclaimer .Error! Bookmark not defined.Preface . ii1Transaction Instruction (TI) Introduction . 11.1 Background . 1Overview of HIPAA Legislation . 1Compliance according to HIPAA. 1Compliance according to ASC X12 . 11.2 Intended Use . 12Included ASC X12 Implementation Guides . 33Instruction Tables . 13.1 005010X222A1 Health Care Claim: Professional . 1005010X223A2 Health Care Claim: Institutional. 114TI Additional Information . 174.1 Business Scenarios . 17Bundling (Code Editing) . 174.2 Payer Specific Business Rules and Limitations . 19HealthLink Electronic Transaction Manual . 19Applicability . 19Scope of Companion Document . 19File Naming Conventions . 19PGP Encrypted Files:. 20Decrypted files:. 20Identifying Products (HMO, PPO, Open Access) . 20Identifying Participating Providers Status . 21Provider Taxonomy (Specialty) Codes . 21Identifying A Network (Repricing Organization Identifiers). 22Repricing Messages . 22Professional: Claims 837P (CMS1500) Messages . 22Professional: Billing Provider (2010AA). 23Professional: Pay-To-Provider (2010AB) . 23Professional: Subscriber Name (2010BA) . 23Professional: Payor Name (2010 BB) . 23Professional: Supervising Provider (2310 E) . 23Professional: Billing Provider Communication Number )2010 AA) . 23Professional: Provider Signature on file and Assignments . 23Professional: Claim Frequency Code (Original and Adjustments). 23Professional: Patient Signature Source Code . 24Professional: Related Causes Code . 24Professional: Accident Date . 24Professional: Admission/Discharge Date . 24Professional: Onset of Current Symptom, Illness. 24Professional: Referring/Ordering Physician Information . 24Professional: Purchased Service Provider Name . 24Professional: Other Insurance Information . 24Professional: Rendering Provider Code Qualifier and ID. 25June 2020 005010iii
HealthLink 837 Companion GuideInstitutional: Claims 837I (UB04s) Messages . 25Institutional: Subscriber Group Number and Group Name . 25Institutional: Billing Provider (2010 AA) . 25Institutional: Pay-to-Provider . 25Institutional: Subscriber Name . 25Institutional: Related Causes Code . 25Institutional: Attending Physician Name (2310 A) . 25Institutional: Operating Physician Name (2310 B). 26Institutional: Other Operating Physician Name (2310C) . 26Institutional: Other Insurance Coverage Information . 27Institutional: Revenue Codes. 27HealthLink’s Document Control Number . 27Pricing Methodologies. 28Coordination of Benefits . 28Non-Standard Claims Converted to Standard Claims . 294.3 Frequently Asked Questions . 29What is HealthLink’s policy regarding 997s? . 29What is HealthLink NPI strategy? . 30HealthLink EDI Strategy for NPI . 30NPI Background . 30What is HealthLink 5010 implementation strategy? . 30HealthLink 4010/5010 Implementation Strategy . 30Does HealthLink use a compliance Tool? . 30Compliance Tool. 30What does HealthLink require from Providers for submitting electronic claims? . 30Claim Submissions from Providers . 30How may Payors receive their electronic claims from HealthLink? . 30Claims Submissions to Payors from HealthLink . 30How does HealthLink prefer to receive their eligibility from Payor’s? . 31Electronic Claims and Eligibility . 31Will HealthLink accept PO or Lock Box addresses for a Billing Provider? . 31Will HealthLink continue to accept diagnosis Present on Admission (POA) indicators inREF segments that the industry used with HIPAA 4010 claims? . 31Which type of claim should Providers use for Anesthesia claims? . 314.4 Other Resources . 325010 Technical Reports Type 3 . 32http://www.wpc-edi.com/ . 32Latest Code Lists . 325010 and ICD-10 Final Rule . 32Appendix A Repricing Organization Identifiers and Descriptions . 33Appendix B National Care Networks (NCN) Identifiers and Descriptions . 365TI Change Summary . 406Communication / Connectivity Instructions. 40HealthLink 5010 Support. 40EDI Support. 40Transmission Methods . 40June 2020 005010iv
HealthLink 837 Companion Guide1Transaction Instruction (TI) Introduction1.1 BackgroundOverview of HIPAA LegislationThe Health Insurance Portability and Accountability Act (HIPAA) of 1996 carries provisions foradministrative simplification. This requires the Secretary of the Department of Health and HumanServices (HHS) to adopt standards to support the electronic exchange of administrative andfinancial health care transactions primarily between health care providers and plans. HIPAAdirects the Secretary to adopt standards for transactions to enable health information to beexchanged electronically and to adopt specifications for implementing each standard HIPAAserves to: Create better access to health insurance Limit fraud and abuse Reduce administrative costsCompliance according to HIPAAThe HIPAA regulations at 45 CFR 162.915 require that covered entities not enter into atrading partner agreement that would do any of the following: Change the definition, data condition, or use of a data element or segment in astandard. Add any data elements or segments to the maximum defined data set. Use any code or data elements that are marked “not used” in the standard’simplementation specifications or are not in the standard’s implementationspecification(s). Change the meaning or intent of the standard’s implementation specification(s).Compliance according to ASC X12ASC X12 requirements include specific restrictions that prohibit trading partners from: Modifying any defining, explanatory, or clarifying content contained in theimplementation guide. Modifying any requirement contained in the implementation guide.1.2 Intended UseThe Transaction Instruction component of this companion guide must be used inconjunction with an associated ASC X12 Implementation Guide. The instructions in thiscompanion guide are not intended to be stand-alone requirements documents. ThisJune 2020 0050101
HealthLink 837 Companion Guidecompanion guide conforms to all the requirements of any associated ASC X12Implementation Guides and is in conformance with ASC X12’s Fair Use and Copyrightstatements.June 2020 0050102
HealthLink 837 Companion Guide2Included ASC X12 Implementation GuidesThis table lists the X12N Implementation Guides for which specific transactionInstructions apply and which are included in Section 3 of this document.Unique IDName005010X222A1Health Care Claim: Professional (837)005010X223A2Health Care Claim: Institutional (837)June 2020 0050103
HealthLink 837 Companion Guide3Instruction TablesThese tables contain one or more rows for each segment for which a supplementalinstruction is needed.LegendSHADED rows represent “segments” in the X12N implementation guide.NON-SHADED rows represent “data elements” in the X12N implementation guide.3.1005010X222A1 Health Care Claim: ProfessionalLoopReferenceName2010AANM1Billing Provider Name2010AANM101Entity Identifier Code852010AANM102Entity Type erence2010AAPERBilling Provider Last orOrganizational NameIdentification CodeQualifierXXXXBilling Provider IdentifierNameCodesPER04Communication Number2010AAPER06Communication Number2010AAPER08Communication NumberLoopReference2000BSBR2000BSBR09NameCodesIf this field is blank, HealthLink willpopulate the data element.If this field is blank, HealthLink willpopulate the data element.If this field is blank, HealthLink willpopulate the data element with“9999999999”.Notes/CommentsIf this field has invalid characters,HealthLink will populate the data in thefollowing manner: “0000000000” (tenzeros)If this field has invalid characters,HealthLink will populate the data in thefollowing manner: “0000000000” (tenzeros)If this field has invalid characters,HealthLink will populate the data in thefollowing manner: “0000000000” (tenzeros)Notes/CommentsSeveral of the payors for which we repriceclaims utilize HealthLink’s Open Accessnetwork products for some of their groups.Subscriber InformationClaim Filing IndicatorCodeNotes/CommentsOccasionally, we will receive electronicclaims with Billing Provider information, butno Provider name and/or Provider ID forthis, which is required under HIPAA.Per CMS HIPAA guidance, telephonenumbers should consist only of tennumeric digits. Dashes and parenthesismarks are invalid characters.Billing Provider ContactInformation2010AAJune 2020 005010Codes12The payor may utilize the followingmethod to determine the status of theprovider who rendered the service.1
HealthLink 837 Companion Guide2000BSBR09Claim Filing IndicatorCodeHMThe payor may utilize the followingmethod to determine the status of theprovider who rendered the service.2000BSBR09Claim Filing IndicatorCodeZZThe payor may utilize the followingmethod to determine the status of theprovider who rendered the service.2000BSBR09Claim Filing IndicatorCodeWCThe payor may utilize the followingmethod to determine the status of theprovider who rendered the service.2000BSBR09Claim Filing IndicatorCode14The payor may utilize the followingmethod to determine the status of theprovider who rendered the service.LoopReferenceName2010BANM1Subscriber Name2010BA2010BANM101NM102Entity Identifier CodeEntity Type QualifierIL12010BANM103Subscriber Last NameXX2010BANM104Subscriber First NameXX2010BANM108Identification Code QualifierMI2010BANM109Subscriber PrimaryIdentifierJune 2020 005010CodesNotes/CommentsOccasionally, we will receiveelectronic claims with Subscriberinformation, but no Subscriber nameand/or Subscriber ID for this, whichis required under HIPAA.If this field is blank, HealthLink willpopulate the data element.If this field is blank, HealthLink willpopulate the data element.If this field is blank, HealthLink willpopulate the data element.If this field is blank, HealthLink willpopulate the data element with“9999999999”.2
HealthLink 837 Companion GuideLoopReferenceNameCodes2010BBNM1Payer Name2010BB2010BBNM101NM102Entity Identifier CodeEntity Type QualifierPR22010BBNM103Payer Last NameXX2010BBNM104Payer First NameXX2010BBNM108Identification Code QualifierPI2010BBNM109Payer IdentifierLoop2300ReferenceCLMNameClaim InformationCodesNotes/Comments2300CLM05-3Claim Frequency Code1If the claim is original to HealthLink, CLM053 in the 2300 loop will be populated with “1”(“Original claim”).2300CLM05-3Claim Frequency Code7If this is an adjustment to a claim previouslyprocessed by HealthLink, CLM05-3 will bepopulated with “7” (“Replacement claim”).2300CLM06Provider or SupplierSignature IndicatorYIf this field is blank, HealthLink will populatethe data element.2300CLM07Medicare Assignment CodeAIf this field is blank, HealthLink will populatethe data element.If CLM09 (Release of Information Code)does not equal “N”, this code is required. IfCLM10 is blank, HealthLink will populate thedata in the following mannerOccasionally, we will receive electronicclaims with Payor information but no Payorname and/or Payor ID for this, which isrequired under HIPAA.2300CLM10Patient Signature SourceCodePLoopReferenceNameCodes2300CLM11Related Causes Information2300CLM11-1Related Causes CodeOALoopReferenceNameCodes2300DTPDate - Accident2300DTP01Date Time QualifierJune 2020 005010Notes/CommentsIf this field is blank, HealthLink will populatethe data element.If this field is blank, HealthLink will populatethe data element.If this field is blank, HealthLink will populatethe data element.If this field is blank, HealthLink will populatethe data element with “9999999999”.Notes/CommentsIf an Accident Date is provided on the claimthe assumption is that the condition beingreported is Accident or Employment related.In these cases a Related-Causes Code isrequired in the 837.If this field is blank, HealthLink will populatethe data element.Notes/CommentsIf an Accident indicator is provided on theclaim the assumption is that the conditionbeing reported is Accident or Employmentrelated. In these cases an Accident Date isrequired in the 837.4393
HealthLink 837 Companion Guide2300DTP02Date Time Period FormatQualifier2300DTP03Accident DateLoopReferenceName2300DTPDate - Admission2300DTP012300DTP02Date Time QualifierDate Time Period FormatQualifier2300DTP03Related HospitalizationAdmission DateLoopReferenceName2300DTPDate - Discharge2300DTP012300DTP02Date Time QualifierDate Time Period FormatQualifier2300DTP03Related HospitalizationDischarge DateLoopReferenceName2300DTPDate - Onset Of nset of Current Illness orInjury DateLoopReferenceName2300REFRepriced Claim Number2300REF01Reference IdentificationQualifier2300REF02Repriced Claim ReferenceNumberLoopReference2300REFJune 2020 005010Date Time QualifierDate Time Period FormatQualifierNameAdjusted Repriced ClaimNumberD8If this date is blank or invalid, HealthLink willpopulate the following data element with"19010101"CodesNotes/CommentsIf a discharge date is present on the claim,the admission date is required.435D8If this date is blank or invalid, HealthLink willpopulate the following data element with"19010101"CodesNotes/CommentsIf an admission date is present on the claim,the discharge date is required.96D8If this date is blank or invalid, HealthLink willpopulate the following data element with"19010101"CodesNotes/CommentsIf the claim indicates there was a relatedillness or symptoms but does not have avalid date. HealthLink will populate with adefault value.431D8CodesIf this date is blank or invalid, HealthLink willpopulate the following data element with"19010101"Notes/CommentsHealthLink assigns a unique DocumentControl Number (“DCN”) (11 digits) to eachclaim that it processes.9AThe DCN assigned to the claim has astructure which uses the DCN“E1804021010” as an example: See section4.2.3.9CodesNotes/Comments4
HealthLink 837 Companion GuideREF01Reference IdentificationQualifier2300REF02Adjusted Repriced ClaimReference NumberLoopReference2300REF2300REF012300NameClaim Identifier ForTransmissionIntermediariesReference IdentificationQualifier9CThe DCN assigned to the claim has astructure which uses the DCN“E1804021010” as an example: See section4.2.3.9CodesNotes/CommentsD9Clearinghouse Trace NumberThe DCN assigned to the claim has astructure which uses the DCN“E1804021010” as an example: See section4.2.3.92300REF02Clearinghouse TraceNumberLoopReferenceName2300HCPClaim Pricing/RepricingInformation2300HCP01Pricing Methodology02300HCP13Reject Reason CodeT12300HCP15Exception Code3June 2020 005010CodesNotes/CommentsThe provider participating status can beobtained in the “Line Pricing/RepricingInformation” segment (“HCP”). If a claim hasbeen processed as non-participating, thefollowing elements will be populated:The presence of this value indicates thatthis claim is from a non-participatingprovider.Claims for non-participating providers usingUCR pricing do not use “00”.Cannot identify Provider as TPO (ThirdParty Organization) Participant)Services or Specialist not in Network5
HealthLink 837 Companion GuideLoopReferenceName2310ANM1Referring Provider ity Identifier CodeEntity Type QualifierReferring Provider LastNameReferring Provider FirstName2310ANM108Identification Code QualifierXX2310ANM109Referring Provider IdentifierLoopReferenceName2310BNM1Rendering Provider Name2310BNM108Identification Code Qualifier2310BNM109Rendering sing Provider Name2310D2310DNM101NM1022310DNM103Entity Identifier CodeEntity Type QualifierSupervising Provider LastName2310DNM104Supervising Provider FirstName2310DNM109Supervising ProviderIdentifierJune 2020 005010CodesXXXXNotes/CommentsOccasionally, we will receive claims withReferring Physician information but noProvider name and/or Provider ID for thisphysician, which is required under HIPAA.If this field is blank, HealthLink will populatethe data element.If this field is blank, HealthLink will populatethe data element.If this field is blank, HealthLink will populatethe data element.If this field is blank, HealthLink will populatethe data element with “9999999999”.CodesNotes/CommentsOccasionally, we will receive electronicclaims with “Rendering Provider” informationbut no Provider ID Number for thisphysician, which is required under HIPAA.XXIf this field is blank, HealthLink will populatethe data element.If this field is blank, HealthLink will populatethe data element with “9999999999”.CodesNotes/CommentsOccasionally, we will receive electronicclaims with Supervising Provider informationbut no Provider name and/or Provider ID forthis physician, which is required underHIPAA.DQ1XXIf this field is blank, HealthLink will populatethe data element.XXIf this field is blank, HealthLink will populatethe data element.If this field is blank, HealthLink will populatethe data element with “9999999999”.6
HealthLink 837 Companion GuideLoopReferenceNameCodes2320SBROther SubscriberInformation2320SBR01Payer ResponsibilitySequence Number CodeS2320SBR02Individual RelationshipCode212320SBR03Insured Group or PolicyNumber2320SBR04Other Insured Group Name2320SBR09Claim Filing Indicator CodeZZLoopReferenceNameCodes2320OIOther Insurance CoverageInformation2320OI03Benefits AssignmentCertification IndicatorYLoopReferenceNameCodesNotes/CommentsIf the claim contains other insuranceinformation or indicates there is othercoverage, then additional other insurancecoverage information is required.If this field is blank, HealthLink will populatethe data element with “”UNKNOWN.If this field is blank, HealthLink will populatethe data element with “”UNKNOWN.Notes/CommentsIf the claim contains other insuranceinformation or indicates there is othercoverage, then additional other insurancecoverage information is required.If this field is blank, HealthLink will populatethe data element.2330ANM12330A2330ANM101NM102Entity Identifier CodeEntity Type QualifierIL12330ANM103Other Insured Last NameXXIf this field is blank, HealthLink will populatethe data element.2330ANM104Other Insured First NameXXIf this field is blank, HealthLink will populatethe data element.2330ANM109Other Insured IdentifierJune 2020 005010Other Subscriber NameNotes/CommentsIf the claim contains other insuranceinformation or indicates there is othercoverage, then additional other insurancecoverage information is required.If this field is blank, HealthLink will populatethe data element with “9999999999”.7
HealthLink 837 Companion GuideLoopReferenceName2330BNM1Other Payer Name2330B2330BNM101NM102Entity Identifier CodeEntity Type QualifierPR22330BNM103Other Payer Last orOrganization NameXXIf this field is blank, HealthLink will populatethe data element.2330BNM108Identification Code QualifierPIIf this field is blank, HealthLink will populatethe data element.2330BNM109Other Payer LoopReference2400HCPCodesIf this field is blank, HealthLink will populatethe data element with “9999999999”.CodesProfessional ServiceService Unit CountNameLine Pricing/RepricingInformationNotes/CommentsIf the claim contains other insuranceinformation or indicates there is othercoverage, then additional other insurancecoverage information is required.1Notes/CommentsOccasionally, we will receive electronicclaims without the required Units of Servicefield, which is required under HIPAA.If this field is blank, HealthLink will populatethe data element.CodesNotes/Comments2400HCP01Pricing Methodology0The presence of this value indicates thatthis claim is from a non-participatingprovider.Claims for non-participating providers usingUCR pricing do not use “00”.2400HCP13Reject Reason CodeT1“T1” (Cannot identify Provider as TPO (ThirdParty Organization) Participant)2400HCP15Exception Code3“3” (Services or Specialist not in Network)June 2020 0050108
HealthLink 837 Companion lly, we will receive electronicclaims with “Rendering Provider” informationbut no Provider ID Number for thisphysician, which is required under HIPAA.2420ANM1Rendering Provider Name2420ANM108Identification Code Qualifier2420ANM109Rendering ed Service ProviderName2420BNM101Entity Identifier CodeQB2420BNM102Entity Type Qualifier12420BNM108Identification Code QualifierXX2420BNM109Other Payer PrimaryIdentifierLoopReferenceName2420ENM1Ordering Provider Name2420E2420ENM101NM102Entity Identifier CodeEntity Type QualifierDK12420ENM103Ordering Provider LastNameXXIf this field is blank, HealthLink will populatethe data element.2420ENM104Ordering Provider FirstNameXXIf this field is blank, HealthLink will populatethe data element.2420ENM108Identification Code QualifierXXIf this field is blank, HealthLink will populatethe data element.2420ENM109Ordering Provider IdentifierJune 2020 005010XXIf this field is blank, HealthLink will populatethe data element.If this field is blank, HealthLink will populatethe data element with “9999999999”.CodesNotes/CommentsOccasionally, we will receive claims withPurchased Service Provider information butno Provider name and/or Provider ID for thisphysician, which is required under HIPAA.If this field is blank, HealthLink will populatethe data element.If this field is blank, HealthLink will populatethe data element with “9999999999”.CodesNotes/CommentsOccasionally, we will receive claims withOrdering Physician information but noProvider name and/or Provider ID for thisphysician, which is required under HIPAA.If this field is blank, HealthLink will populatethe data element with “9999999999”.9
HealthLink 837 Companion lly, we will receive claims withReferring Physician information but noProvider name and/or Provider ID for thisphysician, which is required under HIPAA.2420FNM12420F2420FNM101NM102Entity Identifier CodeEntity Type QualifierDN12420FNM103Referring Provider LastNameXXIf this field is blank, HealthLink will populatethe data element.2420FNM104Referring Provider FirstNameXXIf this field is blank, HealthLink
Jun 02, 2020 · Loop Reference Name Codes Notes/Comments 2300 CLM Claim Information 2300 CLM05-3 Claim Frequency Code 1 If the claim is original to HealthLink, CLM05-3 in the 2300 loop will be populated with “1” (“
Standard Companion Guide . Health Care Claim: Professional (837P) Based on ASC X12N Implementation Guide, Version 005010X222A1 . Companion Guide Version Number: 6.1, May 2020 . CMS 837P Version 005010 Companion Guide ii . CMS 837P Version 005010 Companion Guide iii
A Companion to Greek Tragedy Edited by Justina Gregory A Companion to Classical Mythology Edited by Ken Dowden A Companion to Greek and Roman Historiography Edited by John Marincola A Companion to Greek Religion Edited by Daniel Ogden A Companion to Greek Rhetoric Edited by Ian Worthington A Companion to Roman Rhetoric Edited by William J .
A Companion to Greek Rhetoric Edited by Ian Worthington A Companion to Ancient Epic Edited by John Miles Foley A Companion to Greek Tragedy Edited by Justina Gregory A Companion to Latin Literature Edited by Stephen Harrison A Companion to Greek and Roman Political Thought Edited by Ryan K. Balot A Companion to Ovid Edited by Peter E. Knox
A Companion to Greek Tragedy Edited by Justina Gregory A Companion to Latin Literature Edited by Stephen Harrison . A Companion to Greek Religion Edited by Daniel Ogden A Companion to Greek Rhetoric Edited by Ian Worthington A Companion to Roman Rhetoric Edited by William Dominik and Jon Hall A Companion to Classical Tradition Edited by Craig .
A Companion to Ancient Epic Edited by John Miles Foley A Companion to Greek Tragedy Edited by Justina Gregory A Companion to Latin Literature Edited by Stephen Harrison A Companion to Greek and Roman Political Thought Edited by Ryan K. Balot A Companion to Ovid Edited by Peter E. Knox A Companion to the Ancient Greek Language Edited by Egbert .
A Companion to Classical Tradition Edited by Craig W. Kallendorf A Companion to Roman Rhetoric Edited by William Dominik and Jon Hall A Companion to Greek Rhetoric Edited by Ian Worthington A Companion to Ancient Epic Edited by John Miles Foley A Companion to Greek Tragedy Edited by Justina Gregory A Companion to Latin Literature Edited by .
A Companion to Ancient Epic Edited by John Miles Foley A Companion to Greek Tragedy Edited by Justina Gregory A Companion to Latin Literature Edited by Stephen Harrison A Companion to Greek and Roman Political Thought Edited by Ryan K. Balot A Companion to Ovid Edited by Peter E. Knox A Companion to the Ancient Greek Language Edited by Egbert .
1 The Blackwell Companion to Philosophy, Second Edition Edited by Nicholas Bunnin and Eric Tsui-James 2 A Companion to Ethics Edited by Peter Singer 3 A Companion to Aesthetics Edited by David Cooper 4 A Companion to Epistemology Edited by Jonathan Dancy and Ernest Sosa 5 A Companion to Contemporary Political Philosophy
