Essence. EDI Connectivity for. Institutional Claims

Transcription

1 Essence EDI Connectivity for Institutional Claims Revised: December 15, 2011

2 Essence EDI Connectivity for Institutional Claims Table of Contents CHAPTER 1: INTRODUCTION TO THE SSI GROUP, INC SETTING UP EDI CONNECTIVITY... 4 COSTS... 5 CONTACT INFORMATION... 5 CHAPTER 2: INTRODUCTION TO EMDEON... 6 SETTING UP EDI CONNECTIVITY... 7 COSTS... 8 CONTACT INFORMATION

3 Chapter 1: Introduction to The SSI Group, Inc. Essence and The SSI Group, Inc are offering facilities in the Essence network an easy and effective way to submit institutional claims electronically. The SSI Group, Inc. is a national, diversified information technology company established in The SSI Group, Inc. is working with Essence to offer electronic processing for Essence transactions. With approximately 385 employees and 2,200-plus clients nationwide, SSI leads the healthcare field in healthcare claims management technology, EDI platforms and networking. ClickON technology has more than 200,000 built-in edits, delivers HIPAAcertified transactions from Claredi, is EHNAC certified and has 800 payer connections. As a testament to the company s leadership, the company s technology processes 250 million transactions annually, totaling in excess of $300 billion. The SSI Group offers a wide range of provider/payer/physician services and technologies for managing the revenue cycle claims processing (ASP/Direct/Clearinghouse), document management and business office outsourcing for paper claims. Please visit or contact for more information: The SSI Group Inc. :

4 Setting up EDI Connectivity Payer ID Essence Payer ID and Sub ID for The SSI Group, Inc. Institutional Claims: Payer ID and Sub ID Current SSI Clients If you are currently partnered with The SSI Group, Inc. as your clearinghouse, please contact your account representative or to inquire about sending your Essence claims electronically. Current clients will need to open a System Support Request (SSR) and request to start submitting claims electronically to Essence. For more information, please contact the following account representative: Pamela Phillips The SSI Group, Inc. Physician Sales Representative Phone: ext Pamela.Phillips@ssigroup.com Current Connection via Existing Clearinghouse Many clearinghouses already have a connection to The SSI Group, Inc. (e.g. Availity, MedAvant, PayerPath, PostNTrack); therefore, you may be able to utilize your current clearinghouse in order to send Essence claims electronically. To find out if your current clearinghouse has a connection to The SSI Group, Inc., please contact the following account representative: Pamela Phillips The SSI Group, Inc. Physician Sales Representative Phone: ext Pamela.Phillips@ssigroup.com New Clients If a provider is not using a clearinghouse that is currently submitting to The SSI Group, Inc. and they want to send Essence claims to The SSI Group, Inc., please visit or contact : The SSI Group Inc. :

5 Costs Essence handles all transactional costs for claims that are sent through The SSI Group, Inc. There is a monthly fee of $50.00 to be paid by the provider for software and support. Contact Information For more information regarding setup with The SSI Group, Inc. and/or further assistance, please contact: Pamela Phillips The SSI Group, Inc. Physician Sales Representative Phone: ext Pamela.Phillips@ssigroup.com Essence Phone: Phone Toll Free: customerservice@essencehealthcare.com For ongoing support and/or further assistance from The SSI Group, Inc, please contact: The SSI Group, Inc. Help Desk: * *Pacific Region Washington *Eastern Region Indiana/Kentucky *Western Region Missouri/Oklahoma 5

6 Chapter 2: Introduction to Emdeon PO BOX St. Louis, MO ESSENCE WANTS YOUR CLAIMS SUBMITTED ELECTRONICALLY ESSENCE PAYER ID Dear Essence Providers: In an effort to expand our acceptance of electronic claims, streamline claims processing and reduce claims payment turn-around times, we have partnered with an additional vendor/clearinghouse. Payer ID is now activated for sending claims electronically to Essence. If you already submit claims electronically via one of our other Payer ID s then no change is necessary. However, if the claim ID s on your Essence Remittance Notice do not indicate an E in the sixth position, we are not receiving your claims electronically. If you have been unable to send claims via one of our other Payer ID s please use Payer ID when submitting to your system vendor, clearinghouse, or billing service. Please note that the Rendering Provider s NPI and Tax ID need to be registered with Essence Healthcare prior to initiation of electronic claims. If you need assistance with this matter, please call Essence Healthcare Monday-Friday 8:00AM-5:00PM at or toll free at You can also reach us via at customerservice@essencehealthcare.com. Technical questions regarding that submission should be directed to your system vendor, clearinghouse or billing service. However, if you have specific billing, eligibility or benefit questions regarding an Essence member or the Plan, please contact Essence Monday-Friday 8:00AM-5:00PM at or toll free at or via to customerservice@essencehealthcare.com. You can also visit our website at Our goal is the same, to process your claims timely and accurately so let s help ourselves by eliminating the paper and margin for errors by using electronic claims submission. Thank you, Essence 6

7 Setting up EDI Connectivity Payer ID Essence Payer ID for Emdeon Institutional Claims: Payer ID Current Emdeon Clients If you are currently partnered with Emdeon as your clearinghouse, the transition for sending EDI to Essence will be seamless. Just populate our Payer ID on the claim. For questions regarding sending claims via Emdeon, please contact your account representative or to inquire about sending your Essence claims electronically: Emdeon : EMDEON-6 Current Connection via Existing Clearinghouse Many clearinghouses already have a connection to Emdeon (e.g. Availity, Misys, Zirmed); therefore, you may be able to utilize your current clearinghouse in order to send Essence claims electronically. To find out if your current clearinghouse has a connection to Emdeon, please contact to speak to a sales representative: Emdeon Phone: EMDEON-6 New Clients If a provider is not using a clearinghouse that is currently submitting to Emdeon and they want to send Essence claims to Emdeon, they will need to contact to speak to a sales representative: Emdeon Phone: EMDEON-6 7

8 Costs The cost of sending Essence claims to Emdeon will be dependent on the software package utilized by the provider. Please contact Emdeon to speak to a sales representative to determine associated costs. Contact Information For more information regarding setup with Emdeon and/or further assistance, please contact: Emdeon Phone: EMDEON-6 Essence Phone: Phone Toll Free: customerservice@essencehealthcare.com 8