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ELIGIBILITY REQUIREMENTS

Submitting Membership Information

Frequency of Eligibility Transmissions - Third Party Administrators/Carriers are required to submit full eligibility files on active subscribers and dependents at least monthly (and sometimes more frequently), with recent terminations also shown in order to update our files in an automated manner. Excel files are not acceptable transmission methods.

Transfer Process - HealthLink prefers to receive files electronically via:

Information Required - Eligibility files must include all pertinent membership information:

  • Group names and the payor's group numbers
  • HealthLink effective dates
  • Subscriber/dependent information (full name, subscriber social security number, address, gender, birthdate and relationship code)

The change form used by our Information Technology department when a payor plans to make changes in the file transmission method or format, is located on the last page of the specifications document below.

Electronic Eligibility Format Specifications