I'm in Pennsylvania and have used AIM from RAM Software Systems for many years. Medicare claims are sent directly to the carrier HGSAdministrators through a dial-up connection. Early in 2003 RAM Software teamed up with a clearinghouse, Gateway EDI, to facilitate electronic billing of commercial claims. This is working quite well although not all commercial claims can be sent electronically. Some insurers require copies of trip reports to be sent along with the claim (especially auto and w/c), while others just aren't setup to receive ambulance claims electronically.