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 is the acronym for the Health
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
to view HIPAA implementation guides for electronic claims.
here to read "Using the Sagamore Route Code with
To download copies of our 5010 companion documents (PDF's)
please click on the links below.
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.
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.