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Maine.gov > PFR Home > Insurance Regulation > Electronic Claims

Electronic Claims

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.

Last Updated: January 2, 2009