Electronic Claims Filing



	

		
			
EDI

			
EDI stands for Electronic
				Data Interchange. EDI 
				refers to the transfer of electronic data. Sending healthcare claims via EDI 
				has many advantages. Since EDI claims are sent electronically from one computer 
				to another there is no costly paperwork involved. By the time we receive a 
				paper claim through the mail we would have already received an electronic claim 
				and processed it. Reducing printing and mailing costs along with improved 
				accuracy and speed of claim payments makes sending electronic claims extremely 
				cost-effective. Sagamore is very experienced in handling electronic claims and 
				has been receiving electronic claims for many years.
			

			
HIPAA

			
HIPAA is the acronym for the Health
				Insurance Portability 
				and Accountability Act 
				of 1996. Regarding electronic claims, under HIPAA providers and hospitals have 
				one standard way to send an electronic claim and any entity receiving that 
				claim must be able to process it. One of the main reasons this law was passed 
				was to standardize all the different formats for electronic claims. Please 
				click here
				to view HIPAA implementation guides for electronic claims.
			

			
Please click 
					here to read "Using the Sagamore Route Code with 
						HIPAA".
			

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

			

				

					Hospital Claims
					SHN 
								HIPAA Submitter Companion Guide 5010X223A2
				

				

					Professional Claims
					SHN 
								HIPAA Submitter Companion Guide 5010X222A1
				

			
	
			
			
We currently receive electronic claims from several EDI clearinghouses listed below. Please feel free to contact them or Sagamore Member & Provider Services at (800) 320-0015. 
			

			

				

					Allscripts (PayerPath)
					Payor ID 35164
					(804) 560-2400
					www.payerpath.com
				
			
				

					Availity
					Payor ID 35164
					(800) 282-4548
					www.availity.com
				

				

					Capario (MedAvant)
					Payor ID 35164
					(800) 586-6870
					www.capario.com
				
	
				

					CPSI
					Payor ID 35164
					(251) 639-8100
					www.cpsinet.com
				
				
				

					Emdeon / Webmd/ ENVOY / NEIC
					Payor ID 35164
					(800) 215-4730
					www.emdeon.com
				

				

					Gateway EDI
					Payor ID 35164
					(800) 969-3666
					www.gatewayedi.com
				
				
				

					McKesson (RelayHealth)
					
						
Payor ID 4543 (Hospital) 6464 (Professional)

							
					(800) 527-8133
					www.mckesson.com
				

				

					MedAssets / Xactimed
					
					(888) 883-6332
					www.medassets.com
				
				
				

					NDCHealth / Per-Se (RelayHealth)
					 
					(800) 942-3022
					www.relayhealth.com
				

				

					OptumInsight
					Payor ID 35164
					(800) 341-6141
					www.optuminsight.com
				
			
				

					RealMed
					Payor ID 35164
					(877) REALMED
					www.realmed.com
				

				

					Recondo
					
						
Payor ID 35164

							
					(877) 881-7484
					www.recondotech.com
				
				
				

					The SSI Group, Inc.
					Payor ID 35164
					(800) 880-3032
					www.thessigroup.com
				

				

					TK Software Inc.
					Payor ID 35164
					(888) 372-2808
					www.tksoftwareinc.com
				

				

					Zirmed
					Payor ID 35164
					(877) 494-7633
					www.zirmed.com
				

			

			
These are the only clearinghouses with which Sagamore has a direct connection.
				Use of other clearinghouses requires the claims to go through multiple 
				clearinghouses in order to get to Sagamore. Ultimately, one of the 
				clearinghouses listed above must receive the claims in order for them to be 
				loaded into the Sagamore system.
			

			
We at Sagamore do not electronically reject any claims. An intermediary 
				clearinghouse - not Sagamore, generates any electronic rejects a 
				provider may receive. If the Sagamore system is unable to process the claim, it 
				is printed and mailed directly to the provider with a letter of explanation.