Claims Gateway FAQs

EDI COMMERCIAL SUPPORT
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General

Q: What is the first step I need to complete to begin submitting my insurance medical bills electronically to EDI Direct?

A: If you are a clearinghouse, billing agent, software vendor, or provider who has the capability to submit X12N 837 transactions directly to EDI Direct, then you must first enroll with EDI to obtain a trading partner ID and secure logon ID and password. Payer specific information, requirements and enrollment is detailed in our Claims Payer List.

Q: Who do I contact if I have questions regarding procedures, billing codes, or the type of claim I should use?

A: Please refer to the Provider Services information below. You will find the provider services contact information for each of the EDI Direct-offered insurance payers. The provider services department for the specific payer you are submitting the claim/medical bill to will assist you with these types of inquiries.

Q: Who do I contact if I have questions regarding electronic enrollment or need technical assistance concerning electronic submission?

A: You may send us an e-mail or refer to the Contact Us page for payer-specific EDI Technical Support information. Hours and contact numbers vary for each payer.

Q: How do I update my account information, make profile changes or add a payer if I am already a Conduent Trading Partner?

A: Have your Trading Partner ID ready, and complete this form.

Q: If I am an “approved” software vendor, will my providers/clients need to test with EDI Direct?

A: No. As long as your software has been tested and approved by EDI Direct, each of your providers/clients may be placed into production status after completing the necessary enrollment process and contacting EDI Technical Support.

Q: I am a new billing agent. Will my providers/clients need to submit a test submission?

A: No. Only the billing agent is required to submit a test submission.

Q: I successfully submitted my claim/medical bill through EDI Direct, but the payment has not been processed yet. How do I get a status update for the claim/medical bill?

A: EDI Technical Support is not able to answer billing questions or to provide an explanation of claim denials. If you need information on the status of a claim/medical bill after submitting it successfully through EDI Direct, please contact the payer. Contact information for this type of inquiry is furnished by each of our offered payers. Please refer to the Provider Services information listed below.

Provider Services

Have questions regarding coverage, procedures, billing codes, or the type of claim you should use? Already submitted a medical bill/claim successfully and need to obtain a status or find out why it has been denied? For these types of inquiries, please contact the appropriate insurance payer at the contact number listed below.

Gold Coast Health Plan Visit Gold Coast‘s website for more information on this plan. For GCHP Provider and Member Inquiry/Claim Payment Questions: 888-301-1228
HealthyCT 855-208-1641
Liberty Mutual Insurance Company Providers may submit claims to Liberty Mutual for FREE through MD On-line. MD On-line offers a Direct Data Entry (DDE) application that allows Providers to submit medical bills (CMS-1500s) through a web interface to Liberty Mutual Group companies. For further details on MD On-line’s exclusive offer for Liberty Mutual providers and to register to begin submitting claims electronically, visit MD On-Line. LM Provider Services: 800-225-2467 MD On-line: 888-499-5465
XL Health (CIP) 866-679-3119

If you have technical questions related to the testing and submission of electronic transactions containing claims/medical bills, visit the Contact Us page to appropriately route your inquiry to our EDI Technical Support Team.

WINASAP

Q: Can I use WINASAP5010 for any of the payers offered by EDI Direct?

A: No. While the software is free, it is only available for claim submission to select payers. See the full list of supported payers.

Q: How can I obtain a copy of the WINASAP5010 software?

A: You may download the software. Get more information.

Q: What are the hardware and software requirements for submitting WINASAP5010?

A: The requirements are:

  • Windows98 Second Edition, WindowsNT, Windows 2000 (Service Pack 3) Windows XP, Windows Vista and Windows 7 operating system
  • Pentium processor
  • CD-ROM drive
  • 25 megabytes of free disk space
  • 128 Meg RAM
  • Monitor resolution of 800 x 600 pixels
  • Hayes compatible 9600 baud asynchronous modem
  • Telephone connectivity

Q: Who should I contact if I have problems installing and running the new WINASAP5010 software?

A: Please contact the EDI Support Unit by e-mail or refer to the Contact Us page for payer-specific EDI Technical Support information. Hours and contact numbers vary for each payer. If you need hands-on assistance, the Support Unit can arrange to have a field representative visit your location.

Q: Can I submit claims in a format other than WINASAP5010?

A: Yes. You or your billing agent, clearinghouse, or software vendor may program to the format(s) specified in the companion guide for the payer of interest. We publish payer-specific companion guides, which contain details on acceptable formats for each payer. Once you program to the specifications outlined in the companion guide for the payer you wish to submit to, please contact the EDI Technical Support Team to arrange testing.