What communication features are important to you... Speed? Security? Future growth? There are many options you will want to consider so let’s begin by looking at what you could be doing when you communicate with Empire.

Will you want to submit your claims in batch mode? If so, you will need a Claim Management System that can create HIPAA compliant claims and you’ll need file transfer software, so you can send your claim files to your payers.

Many providers want online access so they can enter and correct their claims interactively, on their payer’s Claim System. Online payer systems often provide enhanced features like Claim Status and the insured’s Eligibility Information. Online access requires TN3270 emulation capability.

Let’s begin by looking at the transactions, (files) you could be sending to Empire and the transactions and reports that Empire may be sending to you.

Inbound Files to Empire

Transactions

ANSI 837 - Claims

• Medicare Part A
• Medicare Part B
• Empire Blue Cross Blue Shield (BC & BS)
• Commercial

ANSI 276 - Claim Status Request

• Medicare Part A
• Medicare Part B

ANSI 997 - Receipt Acknowledgement (ANSI-835)

• Medicare Part A
• Medicare Part B

Outbound Files from Empire

Transactions

ANSI 835 - Electronic Remittance Advice

• Medicare Part A
• Medicare Part B
• Empire Blue Cross Blue Shield (BC & BS)

ANSI 997 - Receipt Acknowledgement (ANSI-837)
ANSI 276 - TA1 Interchange Acknowledgement

• Medicare Part A
• Medicare Part B

Outbound Files from Empire (cont.)

Transactions

ANSI 276 - IG Edit Report

• Medicare Part B

ANSI 277 - Claim Status Response

Reports

EMC Receipt Report

• Medicare Part A
• Empire Blue Cross Blue Shield

Confirmation Report

• Medicare Part A
• Medicare Part B

Commercial Provider Daily Statistics Report

Inbound Reject Report - Medicare Part A

Inbound Accept Report - Medicare Part A

Claims Returned to Prov. - Medicare Part A, new biller

Medicare Part B Return Report

More Information

If you would like more detail on inbound and outbound transactions and reports or technical specifications for setting up your file transfer software or TN3270 emulation, see Empire’s TCP/IP User Manual.