Electronic Claims



	

		
			
Electronic Claims

			
Sagamore currently sends electronic claims to a variety of clearing houses and 
				payors. We have found this to be a very fast, accurate and cost-effective 
				method for handling claims. Sagamore has been working with electronic claims 
				using standard transactions since the 1990's and has gained valuable expertise 
				in this field. As more payors are developing the process of receiving 
				electronic claims they are realizing the benefits of being able to 
				automatically download and process claims. For more information regarding 
				testing and setup of electronic claims please contact our 
					EDI Team.
				
Electronic Claim Format

			
Sagamore only utilizes HIPAA compliant electronic claim formats. Please click 
					here
			to view HIPAA implementation guides for electronic claims. We currently accept and send electronic claims in the standard HIPAA 5010 format.
			

				To download copies of our 5010 companion documents (PDF's) 
				please click on the links below.
			

			

				

					Hospital Claims
					SHN 
								HIPAA Payor Companion Guide 5010X223A2
				

				

					Professional Claims
					SHN 
								HIPAA Payor Companion Guide 5010X222A1
				

			
				
			
Sagamore Connectivity

			

			Sagamore payors have several options to choose from when it comes to receiving 
			repriced EDI claims. We are connected to several clearinghouses and support 
			direct connections with many of our payors. Please contact us to discuss which 
			option would work best for your company. We are open to working with other 
			clearinghouses as well.
			

				Here is a current list of clearinghouses we can send repriced EDI claims to:

			

				

					Sagamore Direct Connect
					(800) 632-0353
					EDI Team
				

				

					HealthSmart
					(888) 744-6638
					www.healthsmart.com
				

				

					Emdeon/Webmd
					(800) 215-4730
					www.emdeon.com
				

				

					TK Software Inc.
					(888) 372-2808
					www.tksoftwareinc.com
				

			

			
Data Communications

			
Sagamore's current electronic claims environment supports encrypted internet
			FTP (File
				Transfer Protocol) 
				communication.
			

			
When using FTP, all files must be encrypted since they are being transferred over the Internet. 
				We use 
					PGP (Pretty Good
				Privacy) software to encrypt and decrypt files. Anyone 
				wanting to do FTP with Sagamore must have the PGP software or something 
				compatible.
			

			
Please click here to 
				view Sagamore Data Communication Guidelines (PDF).
			

			
PGP Key For EDI Claims

			
Please click here to 
				obtain our public PGP key.
			

			
Audit Processing

			
For audit purposes, Sagamore has developed a simple confirmation file to verify 
				all claims have been electronically received by the payor. This file consists 
				of total claims, total charges, and record counts. Please click 
					here to review Sagamore's confirmation file layout (PDF).
					We can also accept the ANSI 997 acknowledgement.