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What is EDI & ERA Enrollment?
EDI is permission for the Provider to send the Claims electronically to the Insurance Payer, and ERA (Electronic Remittance Advice) is permission for the Insurance Payer to send details about how Claims were paid or denied, to the Provider. An ERA is an electronic version of the explanation of benefits (EOB).
- EDI: Provider --> Claim ---> Insurance
- ERA: Insurance --> EOB --> Provider
Some Payers, but not all, require EDI Enrollment before you can submit Claims to them electronically.
EDI & ERA Enrollment Tips:
- Only enroll for EDI Enrollment for those Payers that you are contracted with.
- Not all Payers require EDI Enrollment.
- If you do not currently receive ERAs, you are not required by the system to enroll for them, however, some payer may require ERAs as part of their EDI Enrollment.
Enroll Payers in EDI & ERA
- Click Important tile on your homepage.
- Click Go to Pre-Enrollment button.
- Complete the Ensora Clearinghouse Enrollment Survey.
Complete Enrollments with Change Healthcare
Once you have submitted the Enrollment Survey to Ensora Clearinghouse, that team will pull your Enrollment Requests together and send them to Change Healthcare.
- Your Change Healthcare Rep will contact you within 2 business days of Enrollment to gather any additional information needed for you EDI/ERA Enrollment - e.g. Tax ID, Billing NPI, Payers, etc.
- Your Change Healthcare Rep will then submit your enrollment forms to your Payers.
- IF a Payer requires the Provider or Agency to directly submit enrollment via a portal, your Change Healthcare Rep will walk you through the process.
- You Change Healthcare Rep will serve as a consistent contact point through the process and will provide weekly Enrollment Status updates.
- Contact your Change Healthcare Rep for any questions regarding your EDI/ERA Enrollments.
- Change Healthcare will work with you and the Payer to resolve Enrollment rejections.
Click here >> Step 2: Add Apex Electronic Billing Subscription
Once your Payers have been enrolled AND Approved (not just submitted), you will add one of the 3 Apex Electronic Billing Subscriptions to your system Subscription. You can select your desired subscription level, process up to 50 Claims per month, 300 Claims per month, or unlimited Claims per month.