FAQ: Ensora Clearinghouse EDI Enrollment

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Fill Out Forms

• Answer: You only need to complete the paperwork for the ERAs that you would like to receive. If you don’t send to an insurance company often, or prefer to receive paper EOBs, no need to complete that paperwork. Please let Ensora Clearinghouse EDI Enrollment or My Clients Plus know to cancel an enrollment if you no longer need it.

• Answer: We advise that yes, you should complete that section. Even though you are already setup with EFTs the insurance company will reject your ERA application without that info.

• Answer: Yes, many insurance companies' contract with third parties to manage their ERA & EFT program. You will often see Availity, Office Ally, PaySpan, Change Healthcare, etc listed on that form.

I completed the Pre-Enrollment form, how will I know if Ensora Clearinghouse has received it?

• Answer: If you got to the Thank You page, then Ensora Clearinghouse has received your request.   If the payers you selected require enrollment, you will receive an email with instructions on how to complete your forms.  These emails will typically come within 10 days.

Once I fill out the forms, how long will it take for my enrollment to be approved?

• Answer: Enrollment times can vary depending on the insurance company.  Some online applications have an immediate approval time, others can take longer than 45 days. 

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ERA Processing

• Answer: ERA processing generally takes longer than claim enrollment. While typically ERA enrollment will complete (approve or reject) within 30-45 days, many insurance companies take a least 60 days to process. Be aware that industry changes can also delay this time frame. 

• Answer: If you were setup with ERAs through your old clearinghouse, you should receive them through there until you get an approval. Be aware - many clearinghouses will stop sending ERAs to your account if you have stopped sending claims. You should contact your old clearinghouse to let them know to continue to direct them to you.
  If you didn't have ERAs with your old clearinghouse, or this is your first time submitting electronic claims you will receive your EOBs in the same fashion you did before.

• Answer: No, some insurance companies will start sending paper EOBs while the paperwork is processing. They recognize that many clearinghouses shut off ERAs if you aren't using them, so the insurance drops them to paper so you don't miss anything.

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ERA Status 

• Answer: Most insurance companies will only work with a provider’s office on the status of ERA applications. This means that Ensora Clearinghouse is never notified on the acceptance or the rejection of certain forms. If you get an ERA, or get a email from the payer regarding the status of your application - please let Ensora Clearinghouse or the system know so that Apex EDI can update your enrollment status in their system.

• Answer: You will want to call the payer and ask them, “What is the status of my recent ERA application”. The key is that the application has been approved or that a change has been made.

• Answer: No, many insurance companies hire outside firms to manage the paperwork and processing of payments and ERAs. The key is that the application has been approved.

• Answer: The Ensora Clearinghouse goal is to make this as easy as possible for the provider where they can get the status of an ERA application they do. Unfortunately, many insurance companies won’t work with a clearinghouse on the status of this paperwork because they view it as financial/secure information for your office.

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Approved or Rejected?

Missing ERAs

• Answer: The good news is that if you have received ERAs through Ensora Clearinghouse for an insurance company before - it means your enrollment has been approved. Often times, payments will post in a bank account 2-3 days before we receive the ERA from the insurance company. If you are still missing that ERA after a couple of days, contact the system with the following information:
  ** Name of the Insurance, Check #, Check Amount, Organization Name, Tax ID, NPI, & Payment Date **
  
  We will work with Ensora Clearinghouse to research the check(s).

• Answer: The first thing you will want to do is see if your old clearinghouse is still getting those ERAs. If they are, it means your paperwork is still pending and you will want to coordinate with the old clearinghouse on getting those ERAs.
  If your ERAs aren’t at the old clearinghouse or Ensora Clearinghouse, we can open a ticket with them to research what is going on. In order to do that, we will need the following:
  ** Name of the Insurance, Check #, Check Amount, Organization Name, Tax ID, NPI, & Payment Date **
  
  Be aware, that the payer can take several weeks to process these tickets. We will follow up as much as we can though.

• Answer: Please send us over the following information:
  ** Name of the Insurance, Check #, Check Amount, Organization Name, Tax ID, NPI, & Payment Date **
  
  We will open a ticket with Ensora Clearinghouse to research the check. Be aware, many insurance companies put a time limit (typically 60 days sometimes 30 days) on how far back you can request a missing ERA we will do all that we can to get that electronic version, but you might have to reach out for a paper copy as well.

• Answer: Unfortunately, we cannot request ERAs for payments before the paperwork was approved.

• Answer: We understand how frustrating this is and we want to fix it for you! Many insurance companies won't communicate the status of ERA enrollment with Ensora Clearinghouse or the system though the only way we can troubleshoot an issue is to track it through a missing ERA file. In order for us to troubleshoot we need:
  ** Name of the Insurance, Check #, Check Amount, Organization Name, Tax ID, NPI, & Payment Date **
  
  If you are missing multiple checks, please send them to the system. The more check examples the better!

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