Receivers

Payor clients of Medlogix (insurance companies, employer groups, TPAs and more) that accept or route transactions from submitters to Medlogix for adjudication

Frequently Asked Questions (FAQ)

What is my company’s PAYOR ID?

Yes....Medlogix has you covered

Medlogix issues unique Payor IDs to each of their client receivers to help control the flow of EDI even when things change. If another clearinghouse or billing vendor has assigned a proprietary Payor ID to our client's route, our designated EDI clearinghouse (WorkCompEDI, a/k/a AccidentEDI) can accept either identifier and route the billing correctly.

Can submitters use any clearinghouse or billing vendor to reach us via Medlogix?

Yes....Medlogix has you covered

Yes....our designated clearinghouse (WorkCompEDI, a/k/a AccidentEDI) is the largest P&C clearinghouse in the country. They are able to accept EDI directly from submitters or indirectly through a submitter's eBilling trading partner or clearinghouse. To learn more about submitter options please contact our vendor partner at medlogix@WorkCompEDI.com (work comp) or medlogix@AccidentEDI.com (auto-casualty)

Does Medlogix have a solution to receive prospective & retrospective files?

Yes....Medlogix has you covered

Yes....Medlogix can aggregate prospective transactions from submitters as well as handle the exchange of retrospective billing from customers and third-party vendors.

Is my company COMPLIANT with all state jurisdictional EDI mandates?

Yes.....Medlogix has you covered

All of our clients are fully compliant with all state mandate requirements. We offer an array of flexible eBilling submission methods that are sure to meet the needs of our client's submitters.

What is Medlogix doing to help REDUCE MY PAPER submissions?

Yes....Medlogix has you covered

Medlogix institutes a proven Provider Outreach & Education program with its designated EDI vendor partner (WorkCompEDI, a/k/a AccidentEDI) that strategically and tactically targets paper submitters and drives messaging to ensure EDI options are presented. This program was built with over 20+ years of eBilling experience and has proven to dramatically increase the EDI volume to a receiver client.

Can Medlogix help me with ELECTRONIC PAYMENTS to my providers?

Yes....Medlogix has you covered

Medlogix clients will soon be able extend numerous electronic payment modalities to submitters, including (but not limited to) ACH, Digital Checks, Virtual Cards and physical Checks. Customers will also have a robust "opt-out" solution that will ensure submitter satisfaction with selecting the option that is right for their office.

Below are some of the features and services that Medlogix has in place for our receiver clients

HIPAA X12:

  • 837 (Bills: D, P, I & Rx)  (4010A1 & 5010)
    NCPDP (Rx)
  • 275 Patient Information Attachment
  • 997 & 999 Syntax Validation
  • 824 Standards and Jurisdiction* Validation
  • 276/277 (Claims Status)
  • 277U (Unsolicited Claims Status)
  • 835 (Remittance Advice)
  • 278 (Referrals & Prior Authorizations)
  • 820 (Premium Payements)
  • 834 (Enrollment & Disenrollment)

    o  Payor specific validations
    o  Claims aggregation from any source & vendors
    o  BPO: Paper to EDI conversion Services
    o  BPO: Bill / Claims Printing Services
    o  Proprietary formats (to & from clients / partners)
    o  Proprietary EOBs , reports, communications
    o  Proprietary rejection reports

Formats Supported

  • ANSI X12 837
  • NSF (multiple versions)
  • Print Image
  • Industry Standard
  • WorkCompEDI Proprietary
  • Client Proprietary
  • XML
  • HL7

Pre-Adjudication Validation & Scrubbing

  • Claim Files
  • Vendor Files
  • Provider Files
  • Taxonomy Codes
  • State License Numbers

Advanced Transactions

  • Proof of Services (POS)
  • Secondary Party Serving (SPS)
  • Direct to Mail (DTM)
  • Claim # Look-up
  • OCR / Paper-to-EDI
  • EOB-to-EDI
  • Custom Printing & Fulfillment

Bill file generated

  • 837, print image, proprietary, etc.

Attachments indexed

  • PWK, scan/fax with cover sheet/bard code, etc.

Receiving party generates acknowledgement response

  • 997/999/Ack

Receiving party generates bill level notifications/rejections & final remittance

  • 277/824/835

If using clearinghouse, bill level notifications will come from clearinghouse first, then Payor or Bill Review company

Transmission Methods

  • sFTP (File Transfer)
  • HTTPS (web upload)
  • API

PDF

TIFF & JPEG

Formats
Accepted

  • 275 X12 Format (5010 & 6020)
  • PDF
  • TIFF / JPEG / GIF
  • Other Image Formats
  • Submitting attachments before bills or after, as single images or in bulk, independent of a bill (directly from an EMR/document management system) or indexed by a practice billing system.
  • Able to match bills to images submitted using numerous indexing protocols, which provides an easy way to search and share supporting documents.
  • If providers are required to submit specific attachments for a bill, our tools give submitters the ability to classify the type of attachments they are submitting, further helping ensure a “clean submission”.
  • COMING SOON: Orphan attachment submission processes