INSURER FILING GUIDE

HealthLink

Use this public information to prepare your packet, then confirm the route on the insurer's own page.

AT A GLANCE

Claim facts

Member form	Medical Claim Form Number: 24066CEMONHLK Revision: 2026-01 (printed in month/year order) Open the insurer form
Portal upload	NO
Portal path	NO: the current claim form publishes only nonportal submission routes
Mail address	HealthLink, P.O. Box 659986, San Antonio, TX 78265
Fax	(208) 519-4594
Attachments	Provider name and address; patient name; service provided; date of service; amount charged for each service; diagnosis code; procedure code; Tax ID; NPI
Deadline	Not published by the insurer in the current claim form; the FY24 State plan SPD stated 12 months from the date the expense was incurred
Outcome and status	Not published by the insurer
Processing time	Not published by the insurer
Caveats	HealthLink is a network organizer used by multiple payors and employer plans. The State of Illinois behavioral administrator can differ from the medical administrator. Medicare Advantage and Medicaid are outside this read.

STEP BY STEP

Read date: 10-09-2026

Check the State of Illinois program directory and the member ID card before preparing a therapy claim. The current local-government and college directories identify Aetna for behavioral health while HealthLink is the medical plan administrator. NOT PUBLISHED: whether every other HealthLink OAP program uses the same behavioral administrator. https://cms.illinois.gov/benefits/localgovernment/localgovernmentadmindir.html
If HealthLink is the claim payor, download the Medical Claim Form, 24066CEMONHLK, and complete a separate form for each patient and provider. https://soi.healthlink.com/documents/HL_CLAIM_FORM_01-26.pdf
Attach an itemized bill with every listed provider, patient, service, date, charge, diagnosis, procedure, Tax ID, and NPI field. Also include the completed CMS form from the provider. A superbill alone is not enough. https://soi.healthlink.com/documents/HL_CLAIM_FORM_01-26.pdf
NO PORTAL UPLOAD: the current claim form publishes only nonportal submission routes. Do not treat a member account as a claim-upload route. https://soi.healthlink.com/documents/HL_CLAIM_FORM_01-26.pdf
NOT PUBLISHED: a current claim deadline, claim-status path, processing time, or submission confirmation. The FY24 State plan SPD stated a 12-month filing period, but the current plan document and member ID card control. https://soi.healthlink.com/documents/spd_fy24_160000.pdf

Portal upload: NO
Portal: HealthLink Medical Claim Form
Portal path: NO: the current claim form publishes only nonportal submission routes
Mail address: HealthLink, P.O. Box 659986, San Antonio, TX 78265
Fax: (208) 519-4594
Attach: provider name and address; patient name; service provided; date of service; amount charged for each service; diagnosis code; procedure code; Tax ID; NPI
File types: NOT PUBLISHED
File size limit: NOT PUBLISHED
Maximum files: NOT PUBLISHED
One file or separate files: Separate claim form for each patient and provider; include an itemized bill and completed CMS form
Confirmation: NOT PUBLISHED
Status check: NOT PUBLISHED
Processing time: NOT PUBLISHED
Member deadline: NOT PUBLISHED in the current claim form; the FY24 State plan SPD stated 12 months from the date the expense was incurred
Deadline basis: State program and current plan document control; the cited deadline is from the FY24 SPD
Mental health route: State of Illinois program directory and member ID card control; current local-government and college directories identify Aetna for behavioral health while HealthLink is the medical plan administrator

Confirm the address, fax number or portal path on the insurer's own claims page before you send; read on 10-09-2026.

Read on 10-09-2026 from https://soi.healthlink.com/documents/HL_CLAIM_FORM_01-26.pdf. Confirm the address, fax number or portal path on the insurer's own claims page before you send.