Frequently Asked Questions - EDI


Electronic Data Interchange (EDI) FAQ's

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We have tried to answer each question clearly. If you have a question not covered here or an answer we give to one of these questions is not clear, please use the Ask Us link and we will respond as soon as possible. Your question may also be added to this list to help others.

Please include one or all of the following when you send your question so that we can respond to you in the appropriate manner. Thank you!

Don't forget to include:

  • Your Name.
  • The e-Mail address to which you would like the response to go if different from the originating e-Mail address. We will automatically respond to the originating e-Mail address unless you include another "preferred" address.
  • Your Phone Number if you would like someone to call you.
  • Your mailing address if you are requesting a Provider Directory to be mailed to you.

Q. What is EDI?

A. EDI stands for Electronic Data Interchange. EDI refers to the transfer of electronic data. This may be in a standard format or a non-standard format. Sagamore uses EDI mainly for receiving and sending electronic claims.

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Q. What are EDI standards?

A. Sagamore only uses ANSI standard formats to send and receive electronic claims. (ANSI stands for the American National Standards Institute.) This group is responsible for creating and maintaining standard electronic formats for all types of industries. These are commonly referred to as EDI standards. When the term "EDI" is used, it is normally associated with the ANSI standards but NOT always. Someone could say they are doing "EDI" but they may not be using the ANSI standards; they may be referring to a non-standard internal electronic format they are using.

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Q. What is HIPAA and how does it impact EDI?

A. HIPAA is the acronym for the Health Insurance Portability and Accountability Act of 1996. One of the main reasons this law was passed was to standardize all the different formats for electronic claims. Under HIPAA providers and hospitals have one standard way to file an electronic claim and any entity receiving a claim in that format must be able to process it. HIPAA has adopted ANSI version 5010 for the electronic healthcare transactions.

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Q. What electronic formats are available when doing electronic claims with Sagamore?

A. We currently accept and send electronic claims in the standard HIPAA 5010 format.

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Q. On an electronic claim where should the route code be sent?

A. Using the correct route code will speed the handling of your claims. The location of the route code may vary depending on format. Please consult your software vendor for more information. Please click here to read "Using the Sagamore Route Code with HIPAA".

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Q. From whom does Sagamore receive electronic claims?

A. We currently receive electronic claims from several vendors (sometimes referred to as "clearing houses"). For a complete list of the clearinghouses we use click here.

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