Provider Enrollment
  • 24 May 2024
  • 9 Minutes to read
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Provider Enrollment

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    Light
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Article summary

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.


IMPORTANT: ADD USERS BEFORE USING SUPPORT!
Support will only respond to requests from individuals who have been added as users. After signing up for an account, please add all potential users, as support cannot assist non-users. There are no charges for adding users, so ensure everyone who might need to submit support tickets or require onboarding is set up as a user.

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."

Important Information
A billing provider is considered the provider submitted in Block 33 of the claim form.

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 button.
    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 button.
  4.  The provider will be added to the list with their information populated. This information is pulled directly from the NPPES database. 

More Information
A provider should only be added as atypical if they do not have an NPI, and are not required to have an NPI.

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 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 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 .

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   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   Provider button.
IMPORTANT

To allow additional filtering tools when generating reports, users should check the Claim Grouping.

Steps to enable Claim Grouping:

  1. Click the   button next to the Provider.
  2. Select the Show In Claim Group checkbox.
  3.  Click the   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/150claims 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   button. Fill out all the necessary red boxes, and additional paperwork, and then click .
  4.  Click the   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).
More Information
The button allows the form to be emailed to external users who are authorized to complete and sign the form. 
  1. Click the     button. 
  2. In the pop-up window, enter the authorized user's email address, name, phone number, and title. 
  3. Then select   to send the form to the user.




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.  
Warning
Only use the links provided by Claim.MD. Proper enrollment with the payer is only possible through enrollment links and portals that are initiated from Claim.MD. Do not use outside links such as ones found through internet searches or taken from outside websites.


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     button. Click on all the necessary links and complete the information on the third-party sites/portals. 
  4.  Click the   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    button.

More Information
Use the dropdown menu on the top of the screen to switch to Institutional/UB04 enrollments. Unused claim types can be turned off in Account Settings

IMPORTANT
Please note that the status of "completed" is not necessary to start submitting claims. The status may never indicate "complete". As long as the payer has directly communicated that they are accepting claims, these should start being submitted through Claim.MD. This applies to ERA as well.

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     button. Click this button to enroll to receive ERA or look up Eligibility information from this payer. 
IMPORTANT
If a payer's Eligibility is enrolled via Quick Enroll method, the ability to look up eligibility information is available within 24 to 48 hours.
IMPORTANT
It is essential that providers are already credentialed with their payers before enrolling in Claim.MD. 
IMPORTANT
To ensure successful ERA enrollment with the payer, billers / providers need to submit their claims within the first 30 days of enrollment. Otherwise, the enrollment will time out, and they will need to re-enroll with the payer. If the provider used Quick Enrollment, they must create a ticket with Claim.MD support to reset the Quick Enroll function before re-enrolling.

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.

Enrolling in ERA for an NPI Already Associated with Another Account

Please note that in the latest update, multiple accounts can now enroll for claim submission and eligibility using the same NPI and tax ID, without encountering an error. Only one account will be able to enroll for ERA.

However, if you attempt to enroll multiple accounts with the same NPI to a payer ID that is already registered for receiving ERA, the error message will resemble this:

ENROLLMENT STATUS
This NPI / Tax ID is already set up for payer ID 60054. Contact the current receiver to request they dissassociate this enrollment, or open a support ticket for further assistance.
  • For more information on what to do when you encounter this error, please see this article.
  • Generally speaking, the former biller/software company will have to delete the provider record in Provider Enrollment.
  • If the biller/software company cannot be reached, a support ticket can be created with Claim.MD for further action.  


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.



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