IMPORTANT - PLEASE READ

(Click OK at the bottom of this page to proceed to the claim repricing status inquiry)

Overview

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 Information

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 claims status.

Instructions

Checking a Claims Repricing Status

1.   Login in by using your User Name and Password

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 via email.

3.   After logging in you will go to the Claim Repricing Status screen.    Please fill out the provider Tax ID number that was used on the claim, insured's social security number used on claim, date of service for the claim and exact billed charges of 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 the claim.

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 4 required pieces of information correctly.    Remember the search needs provider tax id, insured's social security number, date of service and exact billed charges 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 Covers Period).

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 to process.

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 completed.

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.

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