HFN, Inc.

ProviderPartner

June 2007

In this issue:

v The Predecessor, the Successor, and the Crosswalk

Provider Hyperlinks

Claims Repricing Status

Electronic Claims Submission

Fax Claims to HFN

NPI Information and Submission Form

Payor Listing

Provider Nominations

Provider Group Health Insurance

Provider Fee Lookup

Provider Orientation Schedule

Provider Updates

Other HFN Links

The HFN ProviderPartner is a bi-monthly publication produced by HFN, Inc. For questions or comments, please write us at providerpartner@hfninc.com

HFN, Inc.

1315 W. 22^nd Street

Suite 300

Oak Brook, IL 60523

Phone (630) 954-1232

Fax (630) 954-1308

www.hfninc.com

HFN, Inc. ProviderPartner – June 2007

The Predecessor, the Successor, and the Crosswalk

The Predecessor, the Successor, and the Crosswalk:  the UB-92, the UB-04 and the Crosswalk have been the buzz in recent weeks since implementation of the new claim forms. Naturally, we created a little buzz of our own. The claim form changes subsequently required us to update our claim repricing statements.

HFN offers a secured on-line Claims Repricing Status functionality at www.hfninc.com. This user-friendly tool allows network providers to review the status of their claims that have been sent to HFN to reprice. You also have the opportunity to view claim detail by clicking on the words "view claim detail"; an actual view of the repriced CMS-1500 or UB-04 claim form will appear. The following crosswalk tables compare the relocated items and identify pertinent repricing information in the HFN Repricing Statement for professional and institutional claims.

HFN UB-92 Repricing Statement	HFN UB-04 Repricing Statement
Payor's Name: Box 2	Payor's Name: above Box 2
Line by line repriced amount: Box 49	Line by line repriced amount: Box 49
Provider's Total Billed Charges: bottom of Box 47	Provider's Total Billed Charges: Totals ð Box 47
Total Repriced Amount: Box 49	Provider's Total Repriced Amount: Totals ð Box 49
Total Savings: Box 56	Total Savings: top line of Box 80
HFN Claim Number: top line of Box 84	HFN Claim Number: above Box 1
HFN Claim Messages (i.e. The DRG Code as entered does not exist.) line two of Box 84	HFN Claim Messages (i.e. The DRG Code as entered does not exist.): below Box 81
Date claim received by HFN: lower right corner of Box 84	Date claim received by HFN: CREATION DATE Box 45

The HCFA-1500 [also known as CMS-1500 (12-90) version], which is used by physicians and suppliers, was updated to accommodate the reporting of the National Provider Identifier (NPI). Although the NPI number could be accepted on claim forms January 1, 2007, it was not required until May 23, 2007 (May 23, 2008 for small health plans or covered entities who have shown “good faith” efforts to be compliant by May 23, 2007). Otherwise, only a few changes affect the HFN CMS-1500 repricing statement. Breaking News: Medicare will reject the old CMS-1500 (12/90) after June 29, 2007.

HFN HCFA-1500 Repricing Statement	HFN CMS-1500 Repricing Statement
HFN Claim Messages (i.e. Provider not under contract for location at this DOS): above Box 1a in the Carrier area	HFN Claim Messages (i.e. Provider not under contract for location at this DOS): above Box 1a in the Carrier area
HFN Claim Number: above Box 1 across from PICA	HFN Claim Number: above Box 1 across from PICA
Payor's Name: above Box 1 next to HFN Claim Number	Payor's Name: above Box 1 next to HFN Claim Number
Line by line repriced amount: Box K	Line by line repriced amount: Box F above billed charge
Total Repriced Amount: below Box 33	Total Repriced Amount: below Box 33b
Total Savings: Box 33 under Total Repriced Amount	Total Savings: Box 33b under Total Repriced Amount
Type of Service*: Box 24C	EMG: Box 24C
Date claim received by HFN: below Box 32	Date claim received by HFN: below Box 32b

*The new CMS-1500 form eliminated the ‘Type of Service’, Box 24C. It is imperative for repricing that the appropriate modifiers are included in Box 24D for anesthesia services.

This issue is ProviderPartner’s farewell issue for the summer. Check our website in the fall for network news.

Inasmuch as, your agreement with HFN requires you to use current claims forms, or applicable successor, or electronic equivalent forms, during this transitional period HFN will continue to reprice claims submitted on the old CMS-1500 (12/90) or UB-92; however, your clearinghouse or the Payor may reject the claim.