Frequently Asked Questions (FAQ)
What is electronic data interchange (EDI)?
It is the transmission of data (medical insurance claims, for instance) from computer to computer, instead of printing to paper and mailing. EDI offers some spectacular advantages over paper, described below.
What is an electronic claim?
It is the same information about patient encounters that you provide to insurers sent by computer instead of U.S. mail.
What is a clearinghouse?
Clearinghouses collect data, i.e. electronic claims, translate it to a digital format that is readable by the recipient, and transmit it. Gateway EDI, a clearinghouse, collects electronic claims from providers and checks for missing or incorrect information using an extensive editing process. Properly formatted claims are then translated into HIPAA compliant ANSI format. They are then grouped and sent in a batch to each insurer. If claims are rejected during the editing process, they are sent back to the provider with a report of the needed corrections. They can then be resubmitted (at no charge, in our case).
Of course, other electronic transactions, like reports from the insurers, remittance advices, claims status, rejection analysis, online eligibility and more are also processed by Gateway EDI.
Why use a clearinghouse?
An electronic clearinghouse is your "one-stop shop" for claims processing. Instead of integrating and communicating with multiple payers, your staff will send claim files to a single location and work with a single, knowledgeable support team. You electronically submit claims to Gateway EDI and we process and route them to the proper payer for adjudication.
Additionally, we offer you several secure Data Tools to help you collect the charges you submit. Our tools offer searchable, categorizable information on every claim you submit through our service.
Why should I send claims electronically?
Bottom line first: you become more efficient, receive payment faster, and recover more of your charges. Additionally:
- You eliminate the time-consuming tasks of printing, stuffing and mailing claim forms.
- You dramatically reduce the time it takes for your claim to reach the payers' computer system. Claims leave your computer, move through the clearinghouse and are sent onto the payers' system within 24 hours.
- Your claims are electronically edited for errors before being forwarded to payers.
- You have proof of filing, unlike mailed claims.
- You bypass the mail delivery service.
- You bypass the payer's mail room.
- You bypass the scanning and re-keying process at the payer location.
Why is a flat, monthly fee more sensible than a per claims fee?
A flat fee will allow you to submit an unlimited number of claims and unlimited resubmission per month for one fixed amount. There's no longer a need to worry whether a small claim is worth submitting.
Is it difficult to get started with Gateway EDI Inc.?
At Gateway EDI our focus is the customer. We make getting started as simple as 1-2-3.
What happens if I encounter difficulties?
Send us an e-mail message or call us! Our customer service department is beyond compare and continuously striving for ways to serve you better and faster.
If you send an e-mail message to customerservice@gatewayedi.com, or if you phone, you will get prompt, professional assistance. Our Automatic Call Distribution (ACD) System ensures our customers speak to the right person, right away.
In addition to rapid response during business hours, Gateway EDI has on-call help available after business hours. We understand that when you need help, you want to have access to our service representatives.
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We went live with Gateway EDI in the 1st quarter of 2004. Our AR Days are now averaging 39-40 days. That's a difference of more than 10 days, which, as you know, makes a HUGE impact on the bottom line.
Lynn Ngo, SSM Health Care, St Louis MO
