Electronic Claims

Electronic Claims

Sagamore currently sends electronic claims to a variety of clearing houses and payors. We have found this to be a very fast, accurate and cost-effective method for handling claims. Sagamore has been working with electronic claims using standard transactions since the 1990's and has gained valuable expertise in this field. As more payors are developing the process of receiving electronic claims they are realizing the benefits of being able to automatically download and process claims. For more information regarding testing and setup of electronic claims please contact our EDI Team.

Electronic Claim Format

Sagamore only utilizes HIPAA compliant electronic claim formats. Please click here to view HIPAA implementation guides for electronic claims. We currently accept and send electronic claims in the standard HIPAA 5010 format.

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

Hospital Claims SHN HIPAA Payor Companion Guide 5010X223A2
Professional Claims SHN HIPAA Payor Companion Guide 5010X222A1

Sagamore Connectivity

Sagamore payors have several options to choose from when it comes to receiving repriced EDI claims. We are connected to several clearinghouses and support direct connections with many of our payors. Please contact us to discuss which option would work best for your company. We are open to working with other clearinghouses as well.

Here is a current list of clearinghouses we can send repriced EDI claims to:

Sagamore Direct Connect (800) 632-0353 EDI Team
HealthSmart (888) 744-6638 www.healthsmart.com
Emdeon/Webmd (800) 215-4730 www.emdeon.com
TK Software Inc. (888) 372-2808 www.tksoftwareinc.com

Data Communications

Sagamore's current electronic claims environment supports encrypted internet FTP (File Transfer Protocol) communication.

When using FTP, all files must be encrypted since they are being transferred over the Internet. We use PGP (Pretty Good Privacy) software to encrypt and decrypt files. Anyone wanting to do FTP with Sagamore must have the PGP software or something compatible.

Please click here to view Sagamore Data Communication Guidelines (PDF).

PGP Key For EDI Claims

Please click here to obtain our public PGP key.

Audit Processing

For audit purposes, Sagamore has developed a simple confirmation file to verify all claims have been electronically received by the payor. This file consists of total claims, total charges, and record counts. Please click here to review Sagamore's confirmation file layout (PDF). We can also accept the ANSI 997 acknowledgement.