Ensora Clearinghouse: Enrollment

The easiest way to understand what a Clearinghouse is and the role it plays in processing your claims and generating revenue for your practice is to see it as a middleman. The clearinghouse picks up electronic claim files (EDI) from your Practice Management Software and forwards them to your respective payer(s) for processing. It then allows the payer to send ERAs (electronic remittance advice or electronic EOBs) through the clearinghouse and back into your Practice Management Software for ease of posting denials and payments.

Enrollment is a process that lets your Payers know that you will be submitting electronic Claims (EDI) and receiving ERAs through Ensora Clearinghouse. It is important to note that Enrollment is NOT the same as getting credentialed with a Payer.

You must be credentialed with each payer you want to submit claims electronically to and receive ERAs back from prior to enrolling for EDI and ERA through Ensora Clearinghouse.

While working through the Enrollment Process, you may come across some keywords and abbreviations that are unfamiliar. Please reference the list below:

• EDI (Electronic Data Interchange): This can also be referred to as 837s. This is simply the electronic version of a claim that is sent to the payer for processing.
• ERA (Electronic Remittance Advice): This can also be referred to as 835s. This is an electronic version of a paper explanation of benefits you receive from the payer once a claim has processed. This will outline any denial or payment information received from the payer.
• Payer ID: This is typically a 5-digit number for electronic claims submission. Payer IDs are usually located on the back of the insurance card under the mailing address.

After you have created your initial enrollment, you can add additional enrollments to ensure any new payers and/or new providers can be billable on claims.

 To submit Claims in the system using Ensora Clearinghouse, you will need to enroll your Payers.

1. Click Organization in primary navigation bar.
2. Click Claims Service in side menu.
3. The Practice and Contact Information will default for you.
4. Select NPI Type, either Individual or Group.
5. Search for desired Payer.
6. Enter all Providers with the NPI Type that you would like to enroll with that Payer.
7. Click Add Additional Payer button and repeat the process to add more Payer Enrollments.
8. OR click Submit when complete.

• The Ensora Clearinghouse Enrollment team will reach out to you within 5 business days of your Enrollment and will then work with you to complete your Enrollments with each Payer. They will also help navigate any rejections.
• Your Enrollments will be delayed if you do not respond when the Ensora Clearinghouse Enrollment team contacts you for additional Enrollment information. 
• If you fail to provide the information needed by the deadline, the Enrollment project will be closed.

• AGAIN - If your Payer did not require Claims enrollment - note add
• After the Enrollment has been processed and your Enrollment is verified as Approved, you can begin billing to those Payers in the system. See Claims Process Overview for more information. 

After you have created your initial enrollment you can add additional enrollments so that I can ensure any new payers and/or new providers can be billable on claims.

1. Click Organization in the primary navigation bar.
2. Click Claims Service in the side menu.
3. Click Add Additional Enrollments.
4. Select NPI Type, either Individual or Group.
5. Search for the desired Payer.
6. Enter all Providers with the NPI Type that you would like to enroll with that Payer.
7. Click the Add Additional Payer button and repeat the process to add more Payer Enrollments.
8. OR click Submit when complete.