Intellect™
THIRD-PARTY VENDOR OPTIONS
Electronic Claims & ERA Third-Party Vendors
(Updated 06/16/2023)
After signup is completed with the clearinghouse, additional enrollments may be required for individual insurance payers prior to submitting claims or receiving Electronic Remittance Advice (ERA) files (see links to clearinghouse Payer Lists below). The supported clearinghouses may offer additional services, as noted below, which must be requested during the signup process.
NOTE: PCS Support must setup the Utility --►Insurance --►Tele Com and Utility --►Insurance --►Insurance screens with your clearinghouse credentials to enable electronic claims submission and ERA download. If not using a supported clearinghouse, contact support@primeclinical.com when you receive your credentials.
Supported Electronic Clearinghouse Options:
All services available via the interface with Intellect are listed for each supported clearinghouse.
INOVALON (formerly Ability)
Electronic Claims, Electronic Remittance Advice (ERA), Electronic Patient Statements, and Eligibility Verification.
For Direct Medicare only (formerly ABILITY Network):
Inovalon Provider, Inc. is a contracted ‘Connectivity Vendor’ for MAC payers. If using this option for a direct connection to Medicare, then all support and fees for this solution are through Prime Clinical Systems.
Contact PCS Support: support@primeclinical.com or 626-449-1705
For All Payers (formerly ABILITY EASE All-Payer):
This solution allows claims submission for ALL payers (including Medicare and Medicaid) through Inovalon.
• Payer List: https://www.inovalon.com/payer-list/
• Enrollment Support and Requests: Enrollment.Support@Inovalon or (888) 499-5464, option 6
• Customer Support: Customer.Support@Inovalon.com or (888) 460-4310, option4
• Account Management: Customer.Success@Inovalon.com
• Billing Inquiries: Accounts.Receivable@Inovalon.com or (612) 460-4311
OPTUM formerly Ingenix/ENS Health)
Electronic Claims, Electronic Remittance Advice (ERA), Electronic Patient Statements, Eligibility Verification, and Claim Scrubbing/Advanced Claim Editing (ACE).
• Professional Claims Payer List: https://iedi.optum.com/iedi/enspublic/Download/Payerlists/Medicalpayerlist.pdf
• Institutional Claims Payer List: https://www.enshealth.com/iedi/enspublic/Download/Payerlists/ENSInstitutionalPayersList.pdf
• ERA Payer List: https://www.enshealth.com/iedi/enspublic/Download/Payerlists/ERAPayerlist.pdf
For New Accounts, Enrollment and Optum Intelligent EDI Portal:
Contact PCS Training Department: train@primeclinical.com or 626-449-1705, option 7
For Established Accounts Only:
Optum Customer Service & Support: 1-866-678-8646 (1-866-OPTUMGO), option 2
DATA DIMENSIONS (formerly WorkCompEDI) - Workers’ Compensation, Auto and Personal Injury
Electronic Claims, File Attachments (any supporting reports and/or forms saved as a PDF file), Second Bill Review (SBR), and Claims Status Inquiry (CSI).
• Payer List: https://datadimensions.com/payor-list/
• Contact: 608-373-6255 or 1-888-996-9903
Non-Partnered Direct Carrier Options:
Electronic claims and ERA are available through these direct carriers on the UNIX and Windows platforms.
Blue Shield of California Direct
• Contact Blue Shield for the necessary Claims, ERA, and EFT enrollment forms.
California Medi-Cal
• Contact Medi-Cal CMC Help Desk: 800-541-5555
• ERA is available online, with manual upload into OnSTAFF Intellect.
Noridian Part B
• https://www.noridianmedicare.com/
WPS
• Contact http://www.wpsic.com/edi/tools/shtml