Electronic Data Interchange
Setting Up Your Account
If you are a contracted provider and have not received your Internet PIN letter, please call our Internet Help Desk at (405) 522-6205 or (800) 522-0114, select option 2, then option 1 to request your PIN.
To establish your secure internet account, use your Internet PIN and log on to the SoonerCare provider portal, where you can view claim status inquiries, claim summaries, and prior authorization inquiries as described in the Provider Billing and Procedure Manual.
If you would like help setting up your website account, and/or training on secure site functions, the SoonerCare Provider Representatives are available to train your billing personnel at your facility.
Submitting claims: Direct Data Entry or Batch
With your SoonerCare Secure Site account, you can submit claims either through direct data entry or a batch file upload. With direct entry option you can submit only one claim at a time. The batch file upload allows you to combine two or more properly formatted claims and submit them at one time.
Batch upload functionality is based on the Electronic Data Interchange (EDI) technology and is the most efficient method of electronic claims submission with the Oklahoma Medicaid Management Information System (OKMMIS). It eliminates many errors, lowers operating costs, reduces turnaround time for payments, and it is free to SoonerCare (Oklahoma Medicaid) providers.
EDI Testing Process and 835 Electronic Remittance Advice (ERA)
- Complete and submit an EDI/ERA Application for Providers or an EDI/ERA Application for Trading Partners/Vendors to Gainwell Technologies by mail or email (see application):
- All clearinghouses, billing agents & vans, please complete the Electronic Data Exchange Agreement and return to Gainwell Technologies by:
- Email - Oklahomaediapps@gainwelltechnologies.com
- Mail - Gainwell Technologies (Attn: EDI Helpdesk)
2401 NW 23rd Street, Suite 11
Oklahoma City, OK 73107
(To be executed, the document must be unedited with signature and contact information.)
- Upon receipt of the appropriate agreements, a member of the EDI team will contact you to answer any questions you might have about the EDI testing process.
- If you are not currently accessing the SoonerCare Secure Site, a PIN letter will be sent to you to allow access to this web site. The SoonerCare Secure Site will be utilized to upload files to and download files from Gainwell Technologies.
- Submit two X12 files with a minimum of twelve transactions. Mirroring of production data is recommended. Upon receipt of two HIPAA compliant files you will be authorized to submit production files.
- HIPAA Companion Documents are available for specific Oklahoma requirements.
- Two weeks of courtesy remittance advice are available after you begin to receive your ERA to allow for testing at your facility.
- After two weeks the paper remits will automatically cease and only 835s will be sent.
- Copies of old paper remits can be requested at any time for a small fee by submitting form HCA-18.
- If you are unable to process the 835, send in the EDI Application for Electronic RA marked to disable 835 and return to paper RA. Please complete promptly to avoid a lapse in your paper remittance advice.
SoonerCare Vendor List
Because a special software is required to submit claims via electronic data interchange, you may consider getting help from one of the SoonerCare Vendors. The Oklahoma Health Care Authority and Gainwell Technologies do not endorse or recommend any of the companies on this listing; moreover, these companies are simply known to be suppliers of EDI-related services.
Note to Suppliers of EDI-Related Services: If you wish to have your organization added or removed from the OK SoonerCare Vendor List, or to update your contact information, please complete and submit the Oklahoma SoonerCare Vendor Form. The listing will be updated on a semi-annual basis.