Welcome to the world of electronic media claims. In an effort to provide the latest in electronic technology,
Per Se is offering direct electronic claims. Each Electronic Claims Direct module gives you the ability to transmit all of the insurance claims your carrier accepts (Medicare Part B, Medicaid, Blue Cross/Blue Shield, and Commercials) in an ANSI format. Electronic Claims Direct Modules are compatible with all
Medisoft programs version 11 or higher.
Most Electronic Claims Direct Modules require a modem and phone line.
Electronic Claims are Faster than Paper
Electronic claims significantly reduce the amount of time a practice waits to be paid for their services. On average, electronic claims are paid in half the time of paper claims. Electronic claims improve payment speed in two ways: First, the mail system is avoided. An electronic claim can arrive at a carrier's office within 24 hours and be ready to be paid by their computer. Contrast this with the time it takes for the post office to deliver the mail and data entry staff at the carrier's office to enter the claim information! Second, insurance carriers give priority processing to electronic claims. Medicare processors cut two weeks off their payment time to give providers the incentive they need to send claims electronically!
Which Claims Can Be Sent Electronically?
MediSoft Direct Electronic Claims software is offered for selected insurance carriers. Medicare, Medicaid and Blue Cross/Blue Shield accept claims directly from providers and billing services in most areas. In most cases, your Medigap secondary claims can be submitted at the same time as your Medicare claims as a crossover claim.
Electronic Claims are as Easy as Paper
Billing data is entered into MediSoft, then is used to print paper claims or submit claims electronically. No additional data entry is required -- Just select the Electronic Claims menu option!
Free Electronic Claims Software Isn't Free
Carrier-supplied software works differently than MediSoft, requiring extra time to learn and use. Claim information must be entered a second time to use carrier-supplied software. MediSoft Direct Claims modules work inside MediSoft, using the same familiar menu structure and commands.
- Carrier Tested and Approved
- Works Inside MediSoft
- No Data Reentry
- No Per-Claim Fee (in most cases, exceptions noted below.)
When a practice sees a concentration of patients who are insured by a particular insurance carrier, direct insurance claims can save the per-claim fee common with claims clearing houses.
Currently Available Direct Claims Modules
The following are currently available MediSoft Direct Claims modules.
Contact us for availability of ERA Auto Pay, a MediSoft product for automatically applying payments based on Medicare's electronic remittance
advice.
Pricing and availability are subject to change. This list was last updated on
March 6, 2006.
Contact Us for additional information or pricing.
(AIM1) Indiana AdminaStar
(Indiana and Kentucky)
This module gives you the ability to transmit your Medicare Part B and
Blue Cross/Blue Shield insurance claims through Indiana AdminaStar in
Indiana and Kentucky.
(APN1) Arizona All Payor
Network
This module gives you the ability to transmit virtually all of your
insurance claims (Medicare Part B, Blue Cross/Blue Shield and Commercials)
through Arizona All Payor Network (APN).
(ARMB) Arkansas Blue Cross/Blue Shield
This module allows Arkansas, eastern Missouri, Louisiana, New Mexico, and Oklahoma providers to transmit Medicare Part B and Arkansas to send Blue Cross/Blue Shield medical insurance claims, all through Arkansas Blue Cross/Blue Shield
(ARMB).
(AVAP) Availity All Payer
The Availity All Payer (AVAP) module is a result of the Availity merger with The Health Information
Network (THIN) and replaces the GPNT THIN module. AVAP accepts claims for Medicare Part B,
Medicaid, Blue Cross/Blue Shield, and Commercial payers.
NOTE: Existing GPNT THIN customers will continue to send claims through THIN but will have
to migrate to AVAP by 12/31/07 or select an alternate EDI solution by this date. New enrollments
will use the AVAP direct module.
To send and receive transactions using AVAP, you must have access to the Internet. Go to the following
link for specific requirements:
http://www.availity.com/services_connected.htm
(CAMC) California Medi-Cal
This module gives you the ability to transmit all of your Medical/Physician insurance claims directly to California Medi-Cal (CAMC).
(CIGN) CIGNA Medicare
This module gives you the ability to transmit your Idaho, North Carolina, and Tennessee Medicare Part B insurance claims directly through CIGNA Medicare
(CIGN).
(CIPA) IPA - California
This module gives you the ability to transmit all of your HMO claims through IPA-California in an ANSI format.
(FLCT) Florida Availity, Florida Medicare, and Connecticut Medicare
Florida offers two separate options for sending electronic claims: Medicare Part B and
Availity. Availity will allow you to submit Blue Cross/Blue Shield of Florida, Humana, and other Commercial carriers. Connecticut
providers will send their claims through Medicare.
(FLMC) Florida and Georgia
Medicaid
This module gives you the ability to transmit your Medicaid insurance
claims through ACS EDI Gateway (ACS) in the states of Florida and Georgia.
(GAMS) Georgia and Mississippi Medicare
This module gives you the ability to transmit your Medicare Part B insurance claims through Georgia Medicare (GA
Medicare) and Mississippi Medicare (MS Medicare).
(GPNT) Blue Cross of Idaho, Regence Blue Shield, and Trailblazer Health
This module gives you the ability to transmit virtually all of your insurance claims (Blue Cross, Blue Shield, Commercial, Medicaid, and Medicare) through Blue Cross of Idaho (BCI).
Also, this module can be used to send Medicare Part B in California, Colorado, Hawaii, Nevada, New Mexico, Oklahoma, Delaware, Maryland, South Carolina, Texas, Virginia, Washington DC, and Trailblazer through GPNet.
Finally this module can be used to submit claims through Regence Blue Shield. Regence Blue Shield accepts claims for Illinois Medicare, Illinois IDPA, Michigan Medicare, IL/MI Blue
Cross/Blue Shield, Texas Medicare, New Mexico Medicare, Texas Blue Cross, Texas Medicaid, New Mexico Blue Cross, and Commercials.
(HMSA) Hawaii Medical Services Association
This module gives you the ability to transmit virtually all of your insurance claims (Hawaii Medical Services and Commercials [QUEST and Hawaii Medical Services HMO]) through Hawaii Medical Services
Association (HMSA). Even claims for carriers that do not have the ability to accept claims electronically can be sent to Hawaii Medical Services, which will then print and mail HCFA forms to these companies. You will be charged for postage for these claims.
(INET) Wellmark Blue Cross/Blue Shield
INET accepts claims for
Medicaid, Blue Cross/Blue Shield, and Commercial payers. Even claims for
carriers that do not have the ability to accept claims electronically can
be sent to INET, which will then print and mail HCFA forms to these
companies. You will be charged for postage for these claims. Note: INET
no longer accepts Medicare claims. There is no processing charge for
Medicaid, Blue Cross/Blue Shield, and BAAI claims. However, there is a
charge for processing commercial claims (including those that INET will
print on paper for you).
(NDMB) Noridian Medicare
This module gives you the ability to transmit your Medicare Part B
insurance claims directly through Noridian Medicare (NDMB). NDMB also
accepts Blue Cross/Blue Shield claims for North Dakota and Wyoming.
(NHIC) Medicare of California and New England
Allows you to process your electronic Medicare Part B insurance claims in Northern California, Southern California, Maine, Massachusetts, New Hampshire, and Vermont through Medicare of California and New England
(NHIC).
(NYEB) New York Empire Blue Cross/Blue Shield
This module gives you the ability to transmit virtually all of your insurance claims (Medicare Part B,
Blue Cross/Blue Shield, and commercial) through New York Empire Blue Cross/Blue Shield (NYEB). However, NYEB uses the Empire Data Exchange Network (EDEN) for processing claims. This system uses a proprietary protocol that will not allow other communication packages to interface with it. This EMC module will only convert your claims to an ANSI 4010a1 format. You must use the IVANS program to transmit your Medicare claims to the EDEN system. Contact NYEB for the IVANS program and request the Windows version. Fees may apply.
(NYGH) New York GHI Medicare
This module gives you the ability to transmit your Medicare Part B insurance claims through New York Group Health Medicare
(NYGH).
(NYMA) New York Medicaid
This module gives you the ability to transmit your Medicaid insurance claims through New York Medicaid (NY Medicaid).
(NYUM) New York Upstate
Medicare
This module gives you the ability to transmit your Medicare Part B insurance claims through New York Upstate Medicare
(NYUM).
(PABS) Pennsylvania Blue Cross/Blue Shield
Providers in Pennsylvania can send both Blue Cross/Blue Shield and Medicare claims. Providers in New Jersey, Delaware, District of Columbia, and Maryland can send only Medicare claims.
(TNBB) Blue Cross/Blue Shield of Tennessee
This module gives you the ability to transmit Blue Cross/Blue Shield claims and Blue TennCare ("TennCare") claims through Blue Cross/Blue Shield of Tennessee
(BCBST).
(UHIN) Utah Health Information
Network
This module gives you the ability to transmit your insurance claims
through the Utah Health Information Network.
(WMSC) Premera Blue Cross
This module gives you the ability to transmit virtually all of your insurance claims (Medicare Part B, Labor and Industry, Medicaid, Blue Cross/Blue Shield, and Commercials) through the Premera Blue Cross/MSC (PBC) Bulletin Board in Washington state.
(WPS1) Wisconsin Physicians Service
WPS accepts claims for the
following carriers in Wisconsin: Medicare Part B, EPIC, TRICARE, and WPS
Commercial payers. In addition, WPS accepts Medicare Part B claims for
carriers in Illinois, Iowa, Michigan, and Minnesota.
To order your direct claims module for Medisoft, contact us at 866-890-6777 (toll free)
or 417-890-6777
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