- PLEASE READ
(Click OK at the
bottom of this page to proceed to the claim repricing
HFN is pleased to provide this
Claims Repricing Status functionality to our providers.
We hope you will use this functionality to review the
status of physician and hospital claims that have been
sent to HFN for discounting. HFN has designed
this tool to be user friendly and easy to obtain the necessary
login and password information. Please read
the following information carefully as it will help you
better understand the search functionality and outline
key points as to why some claims may not be found when
using this internet tool. HFN is constantly
striving to improve communications and service to our
providers. If you have comments on how we
can improve this internet tool please send
us an email or call our customer service support line
and share your ideas with one of our specialists.
Definitions and Important
HFN is a Preferred Provider
Organization (PPO). As a PPO, HFN does not
pay claims which are submitted by the providers.
HFN does however apply the contracted provider discount
to the claims which are submitted to our office.
After the discount is applied, the claim is sent to a
Third Party Administrator (TPA) or Payor to pay the provider
claim. The discounted claims are sent by
HFN through the US mail or electronically to the TPA for
payment. HFN does not have the date when the
claim arrived at the TPA or Payor for final processing.
When you find a claim through the use of this tool we
have given you the TPA or Payor phone number to call for
additional payment and benefit information.
Please keep in mind that you can call our customer support
line at any time for assistance with a question regarding
Checking a Claims Repricing
1. Login in by using
your User Name and Password. Logins will be
disabled after 90 days of inactivity.
2. If you forgot
your password and user name please send another Provider
Login Request or call our customer service support
center and we will send you the necessary information
3. After logging
in you will go to the Claim Repricing Status screen.
Please fill out the provider Tax ID number, insured ID
number and the date of service for the claim. Please
note that date of service to be used for a UB92 is the
Admit Date from Box 17 and for a HCFA 1500 it is the first
Date of Service from Box 24.
4. Once this information
is entered you will receive information on the bottom
of the screen that will give you the HFN claim number,
date that the claim was re-priced, re-priced amount and
the name and phone number of the TPA or Payor that you
can call should you have any additional questions regarding
Important Things to Know
When a Claim Status Check Does Not Produce Search Results
or a Claim Payment Does Not Match the Re-priced Amount
from a Search
Please review the following
list of reasons why a claim may not appear when you request
a search or a payment is different from a re-priced amount:
1. Please review
your practice management system to be sure that you have
generated a claim.
2. Please make sure
you have entered the required pieces of information
correctly. Remember the search needs the provider
tax id, insured ID number and date of service of the original claim submitted.
The date of service to use for a HCFA 1500 is the first
from date in box 24A (Dates of Service).
The date to use for a UB92 is the from date in box 6 (Statement
3. HFN may have
not processed your claim yet. HFN makes every
attempt to process claims in 2 to 3 working days, however,
claims may go to the TPA's before coming to our office.
When this occurs claims take additional days
4. HFN may not handle
your claim. Many times we receive claims that
belong to other PPO's or Payors. Please check
you billing information or insured's insurance card to
determine if the claim is going to the correct address.
In addition, HFN may be the PPO as identified on the card
but often times the TPA will receive the claim and apply
the discount themselves using our re-pricing system.
Again, please check the insurance card to make sure that
the claim was sent to the correct place for processing.
5. HFN needed additional
information to process a claim. Many times
we receive claims with missing information.
When this occurs we send the claim back to the provider
with a request for additional information which delays
processing of the claim.
6. A claim can be
sent to HFN for processing, however, because the employee
lives or went to a provider in a state not covered by
HFN we use an HFN partner to re-price the claim.
In these cases the claim is sent to the HFN partner for
processing. The search will supply the partner
name and phone number to call should you need any additional
information. You can also call the HFN customer
support line for assistance.
7. Members change
employers and insurance plans which lead to delays in
processing claims due to the research that needs to be
8. The payment and
EOB(Explanation of Benefits) can be different from the
re-priced amount. The HFN re-priced amount
does not reflect copayments, plan designs and deductibles.
Please call the TPA as indicated on the search
with any additional questions regarding payment.
HFN DOES NOT GUARANTEE THAT
CLAIMS WILL BE FOUND USING THIS SEARCH TOOL, AND THIS
SERVICE IS NOT A SUBSTITUTE FOR EXISTING CUSTOMER SUPPORT.
PROVIDERS ARE ENCOURAGED TO CALL THE CUSTOMER SUPPORT
LINE AT 1-800-295-5444 FOR ASSISTANCE AT ANY TIME.