What is EDI Enrollment?
- EDI (Electronic Data Interchange), also known as Claim Enrollment or 837, allows you to submit claims electronically from your practice management software, through the clearinghouse, to each payer that you are credentialed with for processing.
What is needed from your practice to complete EDI enrollment?
- You will be provided a JotForm link to initiate your request for enrollment; this will be sent to the Enrollment Team. A member of the team will reach out to you to start the enrollment process.
- Please be sure you know which NPI you are credentialed with for each payer, this is the NPI you will be enrolled with.
- If you require Medicaid or Medicare enrollment, please be sure you know your Medicaid Provider ID Number and/or your PTAN.
- You will be provided with any necessary forms and/or instructions needed to complete your EDI enrollment application.
- Forms typically require an Authorized Signature; please be sure you know who is authorized to sign for your practice to avoid any delays in the payer processing your request.
- Certain payers may require enrollment to be completed through their provider portals, in these instances you will be provided with the necessary instructions and information to complete these enrollment requests.
- Once the necessary enrollment forms are completed, the enrollment team will submit these to the corresponding payers on your behalf. They will monitor the progress of the enrollment through approval; once approval is received, you will then be able to submit your claims electronically to the corresponding payer.
What is ERA Enrollment?
- ERA (Electronic Remittance Advice) enrollment, also known as 835, allows you to receive an electronic version of an EOB from the payer into your Practice Management Software for ease of payment posting, working denials, etc.
What is needed from your practice to complete ERA enrollment?
- Once your EDI enrollment is completed and you have begun submitting claims, the enrollment team will get to work on your ERA enrollment.
- You will be provided with any necessary forms and/or instructions needed to complete your ERA enrollment application.
- Forms typically require an Authorized Signature; please be sure you know who is authorized to sign for your practice to avoid any delays in the payer processing your request.
- Certain payers may require enrollment to be completed through their provider portals, in these instances you will be provided with the necessary instructions and information to complete these enrollment requests.
- Please note that many payers utilize a third-party connection for ERA enrollment such as ECHO, Payspan, and Zelis. The Enrollment Team will not be able to access these connections as they are specifically assigned to you. You will be provided with the necessary instructions on how to make the connections from these third parties to the clearinghouse and the enrollment team will be available to set up a meeting to help walk you through this if needed.
- Once the necessary enrollment forms are completed, the enrollment team will submit these to the corresponding payers on your behalf. They will monitor the progress of the enrollment through approval; once approval is received, you will typically start seeing ERAs coming into your Practice Management Software in two to four billing cycles; however, this is payer specific, and you will be given this information based on the payers current guidelines when you receive your approval.
NOTE: You will not be able to submit electronic claims for payers that require EDI enrollment until approval is received from the payer.