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Electronic Claims

• What does the law (24 M.R.S.A. §2985) cover?
• How do I submit claims electronically?
• Submitting claims directly
• Software vendors
• Submitting claims through a clearinghouse
• Submitting claims through a billing service
• If I choose not to bill electronically, how could I possibly get an exemption?
• If I have questions about the law, whom do I contact?

Frequently Asked Questions:
Electronic Claims Submission

What does the law (24 M.R.S.A. §2985) cover?

The new law applies to all providers - including sole practitioners - who submit claims for payment directly with private health insurance companies (e.g., Anthem, Aetna). This law does NOT apply to billing for MaineCare, Medicare, workers compensation, or automobile insurance. It also does NOT apply in situations where providers bill patients directly, and those patients submit claims for reimbursement with their insurance carrier.

How do I submit claims electronically?

There are 3 ways for providers to submit claims electronically with health insurance companies:

• Submit directly to the insurer
• Submit through a clearinghouse
• Submit through a billing service

The Bureau of Insurance provides this information to help providers research electronic claims submission. The Bureau does not endorse or recommend the services of any of the parties on this list; providers must evaluate the usefulness of these services themselves.

 

Submitting claims directly: For more information on submitting claims directly the provider should contact the particular insurance company to which the claim is to be submitted. Information for to some of the insurance companies licensed in Maine can be accessed at:
Anthem - See “Electronic Data Interchange (EDI) Services” or “Electronic Network Systems (ENS) Free Web-based Claims Submission” in the “Provider” section.	800-334-8262
Aetna
CIGNA - For Post-N-Track claims submission service, call or email enrollme@post-n-track.com.	860-632-0572
Harvard Pilgrim Health Care - See “HPHConnect” in the “Provider” section	800-708-4414, option 3, then option 4.
Software vendors: If submitting claims to an insurance company directly, a provider may need medical billing software to ensure that claims are HIPAA-compliant. Some sources for software are:
Anthem: PC-ACE PRO-32 software	800-334-8262
A4 Health Systems	888-672-3282
American Medical Billing Software (specialize in behavioral health practices)	800-339-6390
eClinicalworks LLC	508-836-2700
GBA Health Network Systems	800-421-9497
Genius Solutions	800-645-0955
ICS Software Ltd. (specialize in small practices)	516-766-2129
Medical Management Resources	800-289-3390
Network Systems Incorporated (located in Portland)	800-439-9770
Northern Data Systems Inc. (located in Falmouth)	800-649-7754
Professional Data Management Group	508-949-2985
SoftRix	800-366-5477
Stratford Software	650-692-7970
Submitting claims through a clearinghouse: A provider can send electronic claims to a clearinghouse which - typically for a fee -- makes sure that the claims are HIPAA-compliant, then sends them to the appropriate insurer. Some sources are:
Electronic Network Systems (ENS) Free Web-based Claims Submission	800-341-6141
Cortex EDI	800-485-5977
CPSI	800-711-2774
EClaims	888-576-0800
Emdeon Practice Services	800-845-6592
FreeMedicalClaims.com	973-353-6209
Gateway EDI	800-969-3666
GHN-Online	214-696-5717
IDX Systems	888-439-6584
McKesson	800-482-3784
MedAvant Health	800-586-6870
Medical Claim Corporation	800-822-9916
Misys Healthcare Systems	866-647-9787
NDC Health	800-778-6711
Office Ally	949-464-9129
Paton Data Co.	603-598-8070
Per-Se Technologies	877-737-3773
SSI Group	800-880-3032
Submitting claims through a billing service: A provider can also have their billing service submit electronically to insurers. Some services which are available are:
Affiliated Professional Services	508-273-1215
Automated Medical Systems	800-927-0002
TechSoft Medical Systems	800-432-7557

 

If I choose not to bill electronically, how could I possibly get an exemption?

The Bureau of Insurance’s website - www.maine.gov/insurance - has a waiver application in its “Recent News” box. If you cannot access that application, contact Joanne Rawlings-Sekunda (see below). To request an exemption complete the application and send it to the Bureau for review.

Please bear in mind that exemptions will be granted only in exceptional circumstances and based solely on the standards in the rule. The law is intended to assure that most providers file claims electronically. Providers are encouraged to explore electronic filing as soon as possible.

If I have questions about the law, whom do I contact?

Joanne Rawlings-Sekunda at the Bureau of Insurance, 207-624-8472 or Joanne.Rawlings-Sekunda@maine.gov.

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