Provider Enrollment

Claim.MD's Provider Enrollment page simplifies the paperwork and portal completion process for healthcare providers and billers, allowing them to efficiently enroll with payers to submit claims, receive electronic remittance advice (ERA), and eligibility services.

• Click on Provider Enrollment in the left-hand navigation menu.

Add Provider 

Ensure that all billing providers, including both individual and organizational National Provider Identifiers (NPIs) if applicable, are added to the provider list; however, enrollments should only be finalized when designating the provider as the "Billing Provider."

Adding all billing providers to the provider list, will ensure that all relevant information is included in the system and that claims are processed accurately. This can help avoid delays or denials in payment. Additionally, having all providers in the list allows for easier management and reporting of billing activity.

To add a provider:

1. Click Add Providerbutton.
   1. A pop-up box will display
2.  In the pop-up box enter:
   1.  the Provider NPI number.
      Atypical providers (providers that do not have an NPI) enter only the tax ID.
   2. the Provider Tax ID
   3.  re-enter the Provider Tax ID
      
3.  Click the Continue button.
4.  The provider will be added to the list with their information populated. This information is pulled directly from the NPPES database. 

Adding Multiple Providers via a Spreadsheet

1. Click Add Provider 
2. Skip the Provider NPI and Tax ID fields. Click Import Spreadsheet (XLSX) link on the bottom of the pop-up window.
3.  Click the Choose File button, select the XLSX file on your drive.
   The file must be XLSX format and follow the format for columns in the pop-up (see image).
4.  Click the Upload Files button
   WARNING

   The NPI and Tax ID columns must be all numeric. Other characters, including dashes (-), are not allowed.  
   
   

Edit Provider

When an NPI is entered the provider information will pre-populate with the current data from NPPES.

Sometimes there is missing required data on an NPI record. In this case, a pop-up window will display that the information is not complete. Add the information into the red boxes and click Save Provider .

If a pop-up box window does not display,  it is advised to review and edit the provider information for accuracy. To do this:

1.  Click   Edit button next to the provider.
2.  Make sure the Address, City, State, and Phone number are correct. It is especially important to make sure the full 9 digit zipcode (zipcode +4) is correct.
   There should not be a dash in between the zip code and +4 codes. 
3.  Click   Save Provider button.

Enrollment

After adding providers, the next step is to complete Electronic Data Interchange (EDI) enrollment for each billing provider with every payer that will receive the provider's claims, and/or will return Electronic Remittance Advice (ERA) and Eligibility information to the provider.

• On the Provider List, click on one of the provider records to get to the list of common payers for that provider's geographic region 
• Select whether to view Professional/1500 claims or Institutional/UB04 claim types (claim types can be removed from the dropdown in the Account Settings). 
• If a payer is not in the list, click on the Payer Search field on the top right, and enter the Payer Name or Payer ID search for the exact payer record for enrollment. 

Notice for each payer, there are three columns:

• 1500 Claims
• ERA
• Eligibility. 

Claims, ERA, and Eligibility must to be enrolled separately for each payer. 

No Enrollment Required

If the 1500 Claims column states No Enrollment Required, then no further action is required for enrollment. Claims can be submitted to payers right away!

Auto-Enroll

For Electronic Remittance Advice (ERA) only, if the payer is designated as "Auto-Enroll" in the ERA column, ERA will be received automatically when claims are sent through Claim.MD.

Enrollment Required

If the 1500 Claims, ERA, or Eligibility column for a payer indicates "Enrollment Required," further steps are necessary before enrolling with that payer.

1. Paperwork that needs to be submitted
2. Instructions that need to be followed (such as completing information in payer portals)

Paperwork that needs to be submitted

• This enrollment method usually requires information to be entered, reviewed, and edited in electronic forms with a signature. 
• For payers such as Medicare Part B, the form may need to be entered and signed by an authorized user for that payer. 
• The form may need to be submitted with additional paperwork that is not in the system. 
• A pop-up box will provide additional form instructions. Information will need to be entered for all the incomplete boxes (in red) and/or additional attached documents.

• Once the form and/or attached documents are submitted, a window will display as to next steps. For example, it might say that it will be automatically faxed, in which case, no further steps are needed

  
  

  

Steps:

1.  Click on the provider name in the Provider List.
2.  Find the Payer using the Payer ID number. Oftentimes, this number is found on the back of the patient's insurance card.
3.  Under 1500 Claims column, click the   Enrollment Required button. Fill out all the necessary red boxes, and additional paperwork, and then click Submit Document .
4.  Click the   Enrollment Required button in the ERA and Eligibility columns if using Claim.MD for receiving ERA and looking up Eligibility information under that payer. (Only complete ERA and Eligibility Enrollment if using Claim.MD for these transactions).

Instructions on payer portal enrollments.

• These enrollments usually require additional information to be entered such as entering information into payer portals. Once the information is entered, and/or documents submitted, click the Mark Complete button.  

Click on any specified payer portal links under the Enrollment Instructions

 Steps:

1.  Click on the provider name in the Provider List.
2.  Find the Payer using the Payer ID number. Often times, this number is found on the back of the patient's insurance card.
3.  Under 1500 Claims column, click the   Enrollment Required  button. Click on all the necessary links and complete the information on the third-party sites/portals. 
4.  Click the   Enrollment Required button in the ERA and Eligibility columns if using Claim.MD for receiving ERA and looking up Eligibility information under that payer. (Only complete ERA and Eligibility Enrollment if using Claim.MD for these transactions).
5. Once finished, it is important to click the   Mark Complete button.

Quick Enroll (Available for ERA and Eligibility Only)

If a payer ERA or Eligibility column states Quick Enroll, then this means that the payer has prior authorization for accepting and receiving ERA and Eligibility data with Claim.MD. Note that the Quick Enroll method is only available for ERA and Eligibility, not for 1500 Claims. 

Steps:

1. Click on the provider name in the Provider List.
2. Find the correct Payer using their Payer ID number. Oftentimes this number is found on the back of the patient's insurance card.
3. Under ERA or Eligibility column, if the payer allows this option, it will display a   Quick Enroll  button. Click this button to enroll to receive ERA or look up Eligibility information from this payer. 

Not Available

If a 1500 Claims, ERA, or Eligibility column displays "Not Available", this means that this function cannot be enrolled for electronic transmission with that payer.

Entering a Legacy or Submitter ID:

The Legacy ID serves the purpose of generating claims and automatically populating the provider ID for atypical providers, as there is no NPI designated for atypical situations. Note, the Legacy ID varies for each payer.

Alternatively, when submitting claims to a payer that necessitates a Submitter ID, users can input their provider-specific Submitter ID into the designated field.

Steps for entering Legacy/Submitter ID:

1. Click the arrow to the left of the Payer record. 
2. On the right side, enter the Legacy Provider ID / Submitter ID. 
3. Click the Save button next to the Legacy Provider/ Submitter ID field.