Electronic Claims & ERA Third-Party Vendors
(last updated 03-14-2013)
Electronic Statement Options:
DATABILL
• Phone: 888-638-1002, option #3 (Customer Service)
• FAX: 602-415-1255
•
Contacts: Steve Richards; Email: steve@databill.com
or
Joe Well; Email: joe@databill.com
Electronic Statement options are also available through a supported clearinghouse, as indicated below.
Supported Electronic Clearinghouse Choices:
Electronic Claims, Electronic Remittance Advice (ERA) and Eligibility Verification are available through the supported clearinghouses (OptumInsight, Gateway EDI, ZirMed Inc., and WorkComp EDI) via Internet connection.
Please click for contact information:
•
OPTUMINSIGHT
(Formerly INGENIX / ENS)
Electronic Claims, Electronic Remittance Advice (ERA), Electronic Patient
Statements, and Eligibility Verification
•
GATEWAY
EDI
Electronic Claims, Electronic Remittance Advice (ERA), Electronic Patient
Statements, and Eligibility Verification
•
ZIRMED
Electronic Claims, Electronic Remittance Advice (ERA), and Eligibility
Verification
•
WORK
COMP EDI
Electronic Claims, and File Attachments (special forms; i.e., Green Liens,
PR2, Doctors First Reports).
When requested, Work Comp EDI will send the Practice/Provider a license agreement. This agreement is strictly between WCEDI and the Practice/Provider.
Enrollment is only required for Department of Labor. The Practice /Provider would handle this directly with the payer. Jennifer Jones is the contact for all information (see above), and will pull other team members on as necessary.
Once the Practice/Clients agreement between WC EDI is established, Prime Clinical Systems receives the Login Id and password. Prime will do the Electronic Billing Set Up in the program.
All claims (except for the attachments) are sent electronically and in the 'current' ANSI format.
Any special forms (Green Liens, PR2, Doctors First Reports) can be sent electronically as an 'attachment' to the Electronic Billing file. Click here for attachment information effective version 13.01.11.
Direct Carrier Choices for Electronic Claims and ERA:
Electronic claims and ERA are available through these direct carriers.
Blue Shield of California Direct - Available on UNIX and Windows Platforms
Contact Blue Shield for the necessary Claims, ERA and EFT enrollment forms.
Medicare Palmetto GBA - Available on UNIX and Windows Platforms
Contact Palmetto 866-749-4301 Electronic Billing & ERN/ERA/EOB
California Medi-Cal - Available on UNIX and Windows Platforms
Contact Medi-Cal CMC Help Desk: 800-541-5555
ERA is available online, with manual upload into OnSTAFF Intellect.
WPS - Available on UNIX and Windows Platforms
Contact http://www.wpsic.com/edi/tools/shtml
EDI Contacts:
MAC J5 (IA, KS, MO & NE)
Hotline 866-503-9670
Fax 608-223-3824
Email: EDIMedicareA@wpsic.com
Part A Legacy (formerly Mutual of Omaha)
Hotline 866-734-6656
Fax 402-351-6188
Email: EDIMedicareA@wpsic.com
Part B Legacy (WI, IL & MI)
Hotline 877-567-7261
Fax 618-998-5170
Email: EDIMedicareB@wpsic.com
Part B Legacy (MN)
Hotline 866-380-4742 (option 2)
Fax 952-885-2899
Email: EDIMedicareB@wpsic.com
Tricare & WPS Commercial
Hotline 800-782-2680 (option 2)
TRICARE Marketing 800-782-2680 (option 4)
WPS Marketing 800-782-2680 (option 6)
Fax 608-223-3824
Email: edi@wpsic.com
EDI Support Services Help Desk
Phone 800-967-7902
The following EDI services have their own applications that clients must complete:
Illinois MediCaid - Available on Windows Platform only
https://www.myhfs.illinois.gov
Contact: 877-782-5565
Noridian Part B - Available on UNIX and Windows Platforms
https://www.noridianmedicare.com/
Cahaba - Available on UNIX and Windows Platforms
http://www.cahabagba.com/
NOTE: UNIX Platform must sign up thru their clearing house Windows Platform.
Contact: 866-582-3253
PART A EDI
Email: PartAEDIServices@cahabagba.com
Enrollment Fax: 205-402-5706
Write us: EDI Services Cahaba
Government Benefit Administrators, LLC
PO Box 12967
Birmingham, AL 35202
NOTE: Sending electronic billing directly to and receiving ERAs directly from Medicare via dial up modem requires the installation of a dedicated phone line. If electronic billing submission to connect to Medicare fails, Intellect will attempt to resubmit the claims. Also, if there are connection issues while attempting to pickup reports and/or ERA files, the connection may not disconnect properly. The retries or hung processes will be reflected on your phone bill and may result in excess phone charges. Prime Clinical Systems recommends sending claims through a clearinghouse to avoid additional phone charges.