Medical Billing: Medisoft Electronic Claims Direct for medical billing

Medisoft Product Description

Item# 13

Medisoft Electronic Claims: NDC MEDAVANT & Electronic Claims DIRECT ===>

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!

Electronic Claim Processing Options

1. NDC MEDAVANT EDI Services

NDC MEDAVANT offers a complete package of EDI Solutions
Please click here for EDI ENROLLMENT DOCUMENTS Please send us an Inquiry to EDI@medicserve.com, or call us at
(888) 987-9335, (631) 941-1014 or FAX at (631) 941-1013
for more information, or for an application.

CURRENT NDC MEDAVANT UTILITIES:

Click here to download the current Top 50 Claim Rejection Answers!
Top 50 Reasons for Claim Rejections

Click here to download the latest NDC MEDAVANT Insurance Payer List for your Platform. There are 2 platforms at the current time:

1. STRATUS (prior to 09/04)
THE STRATUS EDI PLATFORM IS BEING PHASED OUT in 2007
Everyone is being migrated to the PHOENIX PLATFORM
STRATUS NDC MEDAVANT Insurance Payer list.pdf
(Click Cancel if a screen pops up asking for a password)

2. PHOENIX (starting at 09/04):
PHOENIX NDC MEDAVANT Insurance Payer list.pdf.
(Click Cancel if a screen pops up asking for a password)

You will need the Acrobat Reader to read .pdf files. Click below if you do not have the Acrobat Reader for a free copy Acrobat Reader

2. Direct Electronic Claims are as Easy as Paper

Carrier Tested and Approved
Works Inside MediSoft
No Data Reentry
Usually No Per-Claim Fee

Currently Available Direct Claims Modules

E.R.A. Auto Pay

(888) 987 - 9335

State	Code	Carrier	Claims Accepted	ERA
AK	AEMA	Aetna (submits to BC/BS of ND)	Medicare Part B	Y
AK	WMSC	Premera Blue Cross	Medicare Part B, Blue Cross and Blue Shield, Commercial
AR	ARMB	Blue Cross and Blue Shield of Arkansas	Medicare Part B, Blue Cross and Blue Shield
AZ	AEMA	Aetna (submits to BC/BS of ND)	Medicare Part B	Y
AZ	APN1	Arizona All Payor Network	Medicare Part B, Blue Cross and Blue Shield, Commercial
CA	CABS	National Heritage Insurance Company	Medicare Part B for Northern California	Y
CA	CAMC	MediCal	MediCal
CO	NDMB	Blue Cross and Blue Shield of North Dakota	Medicare Part B	Y
CT	TRMB	United Health Care	Medicare Part B	Y
DE	MDTB	Maryland Trailblazers (DOS only)	Medicare Part B
DE	DETB	Delaware Trailblazers (Windows only)	Medicare Part B	Y
DC	MDTB	Maryland Trailblazers	Medicare Part B	Y
DC	MHIN	Maryland Health Information Network	Medicare Part B, Blue Cross and Blue Shield, Medicaid, Commercial
FL	FLMB	Blue Cross and Blue Shield of Florida	Medicare Part B, Blue Cross and Blue Shield, Health Options, Champus, Commercial	Y
GA	AEMA	Aetna (submits to BC/BS of AR)	Medicare Part B
HI	AEMA	Aetna (submits to BC/BS of ND)	Medicare Part B
HI	HMSA	Hawaii Medical Service Assoc.	HMSA, Quest, Medicaid
IA	INET	Iowa INET	Medicare Part B, Blue Cross and Blue Shield, Medicaid, Commercial
IL	ILBB	Blue Cross and Blue Shield of Illinois	Medicare Part B, Blue Cross and Blue Shield, Medicaid, Champus, Commercial	Y
IL	WPSI	Wisconsin Paperless System	Medicare Part B	Y
IN	AIM1	Indiana Administar	Medicare Part B, Blue Cross and Blue Shield, Medicaid, Commercial
KY	KYMB	Administar Federal of Kentucky	Medicare Part B, Blue Cross and Blue Shield, Medicaid, Commercial
LA	ARMB	Blue Cross and Blue Shield of Arkansas	Medicare Part B
MA	NHIC	National Heritage Insurance Company	Medicare Part B	Y
MD	MHIN	Maryland Health Information Network	Medicare Part B, Blue Cross and Blue Shield, Medicaid, Commercial
MD	MDTB	Maryland Trailblazers	Medicare Part B	Y
ME	NHIC	National Heritage Insurance Company	Medicare Part B	Y
MI	WPSI	Wisconsin Paperless System	Medicare Part B	Y
MN	TRMB	United Health Care	Medicare Part B	Y
MO	ARMB	Blue Cross and Blue Shield of Arkansas	Medicare Part B for Eastern Montana
MS	TRMB	United Health Care	Medicare Part B	Y
ND	NDMB	Blue Cross and Blue Shield of North Dakota	Medicare Part B, Blue Cross and Blue Shield
NH	NHIC	National Heritage Insurance Company	Medicare Part B	Y
NJ	PABS	Pennsylvania Electronic Medicare Service	Medicare Part B, Blue Cross and Blue Shield, Commercial (NJ physicians need a PA Blue Shield submitter ID to submit commercial claims)	Y
NM	AEMA	Aetna (submits to BC/BS of AR)	Medicare Part B	Y
NM	ARMB	Blue Cross and Blue Shield of Arkansas	Medicare Part B
NV	AEMA	Aetna (submits to BC/BS of ND)	Medicare Part B	Y
NY	GHIC	Group Health Incorporated	Commercial
NY	NYGH	Group Health Incorporated	Medicare Part B for Queens	Y
NY	NYUM	New York Upstate Medicare Division	Medicare Part B for Upstate Area	Y
NY	NYEB	Empire Blue Cross and Blue Shield	Medicare Part B, Blue Cross and Blue Shield, Commercial	Y
NY	NYMA	New York Medicaid	New York Medicaid Primary and Secondary
OH	OHMB	Nationwide Mutual Insurance	Medicare Part B	Y
OH	AIM1	Indiana Administar	Blue Cross and Blue Shield, Commercial
OK	AEMA	Aetna (submits to BC/BS of AR)	Medicare Part B	Y
OK	ARMB	Blue Cross and Blue Shield of Arkansas	Medicare Part B
OR	AEMA	Aetna (submits to BC/BS of ND)	Medicare Part B	Y
PA	PABS	Pennsylvania Electronic Medicare Service	Medicare Part B, Blue Cross and Blue Shield, Commercial	Y
SD	NDMB	Blue Cross and Blue Shield of North Dakota	Medicare Part B	Y
TN	TNBB	Blue Cross and Blue Shield of Tennessee	Medicare Part B, Blue Cross and Blue Shield, Medicaid, Commercial	Y
TX	TXBB	Texas Health Information Network	Medicare Part B, Blue Cross and Blue Shield, Medicaid, Commercial	Y
VA	TRMB	United Health Care	Medicare Part B	Y
VT	NHIC	National Heritage Insurance Company	Medicare Part B	Y
WA	AEMA	Aetna (submits to BC/BS of ND)	Medicare Part B	Y
WA	NDEX	Network Data Express	Medicare Part B, Blue Cross and Blue Shield, Medicaid, Department of Labor and Industries, Commercial
WA	WMSC	Premera Blue Cross	Medicare Part B, Blue Cross and Blue Shield, Medicaid, Department of Labor and Industries, Commercial
WI	WPSI	Wisconsin Paperless System	Medicare Part B	Y
WV	OHMB	Nationwide Mutual Insurance	Medicare Part B	Y
WY	NDMB	Blue Cross and Blue Shield of North Dakota	Medicare Part B, Blue Cross and Blue Shield	Y

MedicServe recommends this product for medical practices and medical billing services, which see a concentration of patients who are insured by a particular insurance carrier. Direct insurance claims can save the "per-claim fee" which is charged normally by claims clearing houses. The NDC MEDAVANT clearing house option on the other hand allows you to have a very efficient and integrated claim management, auto posting and electronic statement operation. NDC MEDAVANT has very competitive rates, 39 cents per claim for Medisoft users, and they maintain a very reliable clearing house option.

You may decide to combine the NDC MEDAVANT option with the Electronic Claims Direct module. If your office has a large relative concentration of patients covered by the ECD module insurance, then it may be cost effective to choose the ECD module for that insurance, and the NDC MEDAVANT clearing house option for all your commercial claims. Please check the chart above to see if a direct claims module exists for your particular area and insurance carrier(s). If it is not there, then the NDC MEDAVANT option is our recommended choice.

Please note: The ECD module requires the Patient Accounting program; it is not a stand alone software application.

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