Forums

Transaction Workgroups

Linxus workgroups are collaborative forums of health plan and provider staff, who define a common understanding around HIPAA code sets used by payers and providers. This ensures that both sides have the same understanding of the transactions sent so that payers are consistent and providers get information that is useful in their daily communications with the health plans.

• Claim Status Workgroup
  The 276/277 transaction details the claim adjudication status of submitted claims (pre-finalization). This Workgroup is developing a standardized implementation approach, that over time, will reduce phone calls and increase transparency and efficiency of pending claims payments to providers.
• Remittance Workgroup
  The 835 transaction lets providers know how their claims are settled and finalized by a health plan (payments, adjustments, and denials). This Workgroup is examining both consistency and comprehensiveness of finalized claim information presented to providers, to reduce phone calls and reach a common understanding about claims processes.
• Eligibility Workgroup
  The 270/271 transaction is used to authenticate a patient’s eligibility for health plan benefits. This Workgroup is developing a standardized implementation approach that ensures consistency and comprehensiveness of benefits coverage information returned by health plans.
• More Workgroups (to come): Linxus is forming additional collaborative Workgroups, and we welcome broad industry participation in these efforts.