Intellect™
THIRD-PARTY VENDOR OPTIONS
Electronic Claims & ERA Third-Party Vendors
(Updated 02/21/2018)
Electronic Statement Options:
PINNACLE DATA SYSTEMS (formerly DATABILL)
• Phone: 888-895-1004
• FAX: 602-415-1255
• Contact: Julie Peters
OPTUMINSIGHT (formerly INGENIX / ENS)
• Please click for contact information
COGNIZANT (formerly TriZetto/Gateway EDI)
• Please click for contact information
Electronic Statement options are also available through a supported clearinghouse, as indicated below.
Supported Electronic Clearinghouse Choices:
Electronic Claims, Electronic Remittance Advice (ERA), and Eligibility Verification are available through the supported clearinghouses (OptumInsight [formerly ENS/Ingenix], Cognizant [formerly TriZetto/Gateway], EDI, ZirMed Inc., and WorkComp EDI) via Internet connection.
Please click for contact information:
• OPTUMINSIGHT (formerly INGENIX / ENS)
Electronic Claims, Electronic Remittance Advice (ERA), Electronic Patient Statements, and Eligibility Verification
Online Client Help Documentation:
OPTUM Web Portal Support Access
OPTUM Web Portal Access Information
• COGNIZANT (formerly TriZetto/Gateway EDI)
Electronic Claims, Electronic Remittance Advice (ERA), Electronic Patient Statements, Eligibility Verification, and CSI (Claims Status Inquiry)
• WAYSTAR (formerly ZIRMED)
Electronic Claims, Electronic Remittance Advice (ERA), and Eligibility Verification
• WORK COMP EDI
Electronic Claims, File Attachments (special forms; i.e., Green Liens, PR2, Doctors First Reports), SBR, and CSI (Claims Status Inquiry).
When requested, Work Comp EDI sends the Practice/Provider a license agreement. This agreement is strictly between WCEDI and the Practice/Provider.
Enrollment is only required for Department of Labor. The Practice /Provider would handle this directly with the payer. Jennifer Jones is the contact for all Work Comp EDI information, and pulls other team members on as necessary.
Once the Practice/Client’s agreement between WC EDI is established, Prime Clinical Systems receives the Login Id and password. Prime does the Electronic Billing Set Up in the program.
All claims (except for the attachments) are sent electronically and in the 'current' ANSI format.
Any special forms (Green Liens, PR2, Doctor’s First Reports) can be sent electronically as an 'attachment' to the Electronic Billing file. Click here for attachment information effective versions 13.01.11 and 14.10.08.
Direct Carrier Choices for Electronic Claims and ERA:
Electronic claims and ERA are available through these direct carriers.
Blue Shield of California Direct – Available on UNIX and Windows Platforms
• Contact Blue Shield for the necessary Claims, ERA, and EFT enrollment forms.
California Medi-Cal – Available on UNIX and Windows Platforms
• Contact Medi-Cal CMC Help Desk: 800-541-5555
• ERA is available online, with manual upload into OnSTAFF Intellect.
WPS – Available on UNIX and Windows Platforms
• Contact http://www.wpsic.com/edi/tools/shtml
Noridian Part B – Available on UNIX and Windows Platforms
• https://www.noridianmedicare.com/
Cahaba – Available on UNIX and Windows Platforms
• http://www.cahabagba.com/
• NOTE: UNIX Platform must sign up through their clearing house Windows Platform.
• Contact: 866-582-3253
NOTE: Sending electronic billing directly to and receiving ERAs directly from Medicare via dial-up modem requires the installation of a dedicated phone line. If electronic billing submission to connect to Medicare fails, Intellect attempts to resubmit the claims. Also, if there are connection issues while attempting to pickup reports and/or ERA files, the connection may not disconnect properly. The retries or hung processes are reflected on your phone bill and may result in excess phone charges. Prime Clinical Systems recommends sending claims through a clearinghouse to avoid additional phone charges.