Provider Validation Required
No Enrollment Required – You Can Submit Claims Immediately
If a payer displays No Enrollment Required for Claims on the Provider Enrollment screen, you can begin submitting claims to that payer immediately. You do not need to complete Provider Validation or a claims enrollment before submitting claims to that payer.
Important: ERA Enrollment Is Separate
Even if a payer does not require enrollment to submit claims, you must still complete ERA enrollment to receive Electronic Remittance Advice (ERA) through Claim.MD. Claims and ERA have separate enrollment requirements, and Provider Validation must be completed before ERA enrollment can be processed. Without Provider Validation, ERA enrollment cannot proceed, and electronic remittances will not be received. Be sure to check the ERA enrollment status for each payer and complete all necessary steps to begin receiving remittances.
Provider Validation (Phone Verification via NPPES)
After you add a new provider in the Provider Enrollment screen, Claim.MD may require Provider Validation to confirm you are authorized to exchange data for the provider's NPI.
Provider Validation is completed when required as part of the provider enrollment process. However, if the payer does not require enrollment for Claims, you do not need to complete Provider Validation before submitting claims to that payer.
Why This Is Required
To verify authorization, Claim.MD places a phone call to an official phone number listed for the NPI in the NPPES database.
When You Will See This
If the provider record shows "Pending Validation Step", Provider Validation must be completed for enrollment processes that require validation.
The provider validation step is completed on the payer enrollment page. If validation is required, the Provider Validation screen displays when a Quick Enroll or Enrollment Required button is pressed.
Note: Payers determine whether enrollment is required for claims submission. If a payer displays No Enrollment Required for Claims, you can submit claims without completing this validation step first. Validation may still be needed when completing other required enrollment processes, such as ERA enrollment.
How to Complete Provider Validation
- Start an enrollment for any payer or transaction that requires it, such as Claims, ERA, or Eligibility.
- The system will display the phone numbers on file in NPPES for that NPI.
- Select a number, then click "Call Now".
- Our AI agent immediately places an on-demand call. The recipient answers and confirms approval for setting up the provider record in Claim.MD.
If No One Is Reachable at the Listed Numbers
If the provider cannot be reached at any phone number listed in NPPES, you have two options:
- Work with a provider representative who can answer at one of the listed numbers, so they know to expect the call and approve it.
- Update the provider's public contact phone numbers in NPPES, then retry validation.
I've Updated My Phone Number in NPPES. What's Next?
Once your phone number has been updated in the NPPES database, you can manually refresh your provider information in Claim.MD without waiting for the next scheduled update.
- In the Phone Number dropdown, select Other Number.
- Click Refresh NPPES Information to retrieve the latest information from NPPES.
Claim.MD will refresh your provider information using the updated NPPES records.
ERA Delivery Options After Validation
ERA Delivery Options After Validation
After completing validation for the first time, providers may see a prompt if another account already has active ERA enrollments for the same NPI/Tax ID. This allows providers to choose whether future ERA should route to the newly validated account.
If ERA is redirected, any existing provider records with active ERA enrollments will move to a Pending Validation status until validation is completed again on those records.
After completing validation, if another account has active ERA enrollments, you will will see this prompt:
