GEHA Claim & 835 Information

In an effort to improve services to our provider community, Government Employees Health Association (GEHA) has engaged Smart Data Solutions to manage its claims, remits, and real-time transactions. This new engagement will allow you to directly submit a compliant claim file in the following formats: 837p and 837i (EDI), direct data entry (DDE) of a claim using the standard Professional/CMS1500 claim form, Institutional/UB04 claim form, Dental claim form, enroll for ERAs through open enrollment, submit an eligibility inquiry directly or by uploading the 270 transaction, and submit a claim status inquiry directly or by uploading a 276 transaction.

Affiliations and Partnerships

Smart Data Stream processes over 500M transactions annually.

Transaction Type

Claims

There are two options to submit a claim through the Smart Data Stream Clearinghouse Portal. You can either upload a claim file or you can do Direct Data Entry (DDE) and key in a new claim. When uploading, you have the ability to upload claims in batches to the portal. As long as it’s a valid 837 file and has a payer ID in the REF02 segment, SDS will successfully route your claims on to the payer. With DDE you can choose a Professional/CMS1500, Institutional/UB04, or Dental claim form. Once the claim type has been selected, it will bring up a template for the claim information to be typed into.

Transaction Type

ERA Enrollment

To assist with ERA routing, we are offering our current trading partners the option to perform bulk provider enrollment through SDS. We will accept any file format from our trading partners that include the proper data elements listed:

  • Provider First Name
  • Provider Last Name
  • Provider Email
  • Provider TIN (required)
  • Provider NPI
  • Provider Address
  • Provider City
  • Provider State
  • Provider Zip

Providers are able to use the open enrollment link to create an account and enroll. Once enrolled, they will have the option to select the trading partner that they would like to have ERAs sent to.

 

Transaction Type

Eligibility

To do an eligibility inquiry, the Provider will have to add the Payer to their eligible Payers.

  1. Go to the Eligibility tab and select “update Payers”.
  2. Then select the Payers you would like to check eligibility for and save.
  3. Now, you will be able to run the inquiry.

Transaction Type

Claim Status

To do a claim status inquiry, the Provider will have to add the Payer to their claim status Payers.

  1. Go to Claim Status tab and select “update Payers”.
  2. Then select the Payers you would like to check claim status for and save.
  3. Now, you will be able to run the inquiry.

Transaction Type

Claims

There are two options to submit a claim through the Smart Data Stream Clearinghouse Portal. You can either upload a claim file or you can do Direct Data Entry (DDE) and key in a new claim. When uploading, you have the ability to upload claims in batches to the portal. As long as it’s a valid 837 file and has a payer ID in the REF02 segment, SDS will successfully route your claims on to the payer. With DDE you can choose a Professional/CMS1500, Institutional/UB04, or Dental claim form. Once the claim type has been selected, it will bring up a template for the claim information to be typed into.

Transaction Type

ERA Enrollment

To assist with ERA routing, we are offering our current trading partners the option to perform bulk provider enrollment through SDS. We will accept any file format from our trading partners that include the proper data elements listed:

  • Provider First Name
  • Provider Last Name
  • Provider Email
  • Provider TIN (required)
  • Provider NPI
  • Provider Address
  • Provider City
  • Provider State
  • Provider Zip

Providers are able to use the open enrollment link to create an account and enroll. Once enrolled, they will have the option to select the trading partner that they would like to have ERAs sent to.

 

Transaction Type

Eligibility

To do an eligibility inquiry, the Provider will have to add the Payer to their eligible Payers.

  1. Go to the Eligibility tab and select “update Payers”.
  2. Then select the Payers you would like to check eligibility for and save.
  3. Now, you will be able to run the inquiry.

Transaction Type

Claim Status

To do a claim status inquiry, the Provider will have to add the Payer to their claim status Payers.

  1. Go to Claim Status tab and select “update Payers”.
  2. Then select the Payers you would like to check claim status for and save.
  3. Now, you will be able to run the inquiry.

Resources

Smart Data Solutions integrates with payers and providers nationwide, offering a host of solutions to make clearinghouse connections easier.

 

270-271 Companion Guide
276-277 Companion Guide
GEHA CAQH CORE Connection Guide
GEHA Provider ERA Enrollment Guide

Contact Information:

  • If you have any questions, you may contact our support Monday-Friday 9:00AM-5:00PM CST at stream.support@sdata.us or 855-297-4436.

Additional Information:

  • Providers do not need an authentication token to login.
Enroll Now 
9,200
Connections
500M
Transactions annually
200,000
Provider connections
Over $1 Billion
in transaction billing per month

Frequently Asked Questions

Can I have more than one TIN/NPI account?

+
x

Yes. A single account can have any number of TIN/NPI combinations.

Do I need to complete the ERA enrollment to check eligibility/claim status?

+
x

No, the ERA enrollment is only if you'd like to receive ERAs. If your account is redirecting you to the ERA enrollment page when you first log in and you don't wish to sign up for ERAs, you may disregard this and go straight to the section you need using the top menu bar.

Why am I getting an error when trying to submit a New Claim/Eligibility Inquiry/Claim Status Inquiry?

+
x

The most common reason for a general error when trying to submit is that no payers have been selected yet. Confirm that the payer you want to connect with has been selected in the Update Payers section of that page.

Why am I getting an error when trying to update my existing ERA enrollment?

+
x

If all required fields of the ERA enrollment form are filled out, but you're still getting an error when submitting, check to make sure that there aren't any empty lines in the Payer Selection area. If there are any empty lines, click on the X to the right to remove it.

These empty lines are from Payers you were previously enrolled for, but who have since discontinued service.

I enrolled for ERAs, but I don't see anything in the account. Where can I find them?

+
x

The ERA enrollment is not retroactive and will only start receiving ERAs for payments issued at least three days after you enrolled. For any previous payments, you'll want to contact the payment vendor or insurance company directly. All ERAs will appear under the Remits tab.

Can I change my username?

+
x

Usernames cannot be changed, but if you'd like a different one you can create a new user for yourself. First use the +Add New User button on the Users page under Account Management. After you've created the user, click on Edit User and grant that user Admin Access.

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