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.