There are two things you may have to worry about when you go digital with your claims. The first is EDI Enrollments and the second is getting yourself set up for Electronic Remittance Advice (ERA). This article will cover the details of EDI Enrollments. For details on ERA Enrollments, please see ERA Enrollments.
EDI Enrollment (clearinghouse authorization)
Some payers, mainly Medicare, Medicaid and BCBS, will require what is called EDI Enrollment (Therabill often refers to it as a clearinghouse authorization). This is a form that you send to the payer letting them know that you will be submitting claims electronically, and what clearinghouse your claims will be going through. You will know when a payer requires EDI Enrollment within Therabill when you are adding the insurance company to an insurance card. If the payer requires EDI Enrollment, you will see a red warning telling you that the payer requires EDI Enrollment in the payer information box on the Add Insurance Card form (see graphic below).
IMPORTANT: When doing EDI Enrollments, you will be enrolling a billing NPI (as opposed to your rendering NPI). You should enroll with the same billing NPI (Box 33A) that you will be submitting to them on your claims. If you will be submitting with multiple billing NPIs, then you will need to do an EDI Enrollment for each of the billing NPIs.
IMPORTANT: Once you have heard back from the payer that they have processed and approved your EDI Enrollment, then you must let Therabill know by contacting support. Once you let Therabill know that you have been approved, we will then verify that the clearinghouse has the approval entered and then enter the approval into our system. You cannot submit to the payer through Therabill until we have the approval entered in our system.
How do I get set up?
Surprise, surprise. There are going to be forms to fill out and maybe even some follow up with the payer and clearinghouse if things don't go smoothly. You will also want to use an enrollment form that has the clearinghouse information pre-filled in for you. You can get the forms and instructions from the following link: Office Ally EDI Enrollments. Click the state you are located in, and you will see the payers for your state that will require an EDI Enrollment. Click the link for the payer and you will see a page with instructions for filling out the enrollment electronically, or an enrollment form that has the clearinghouse information already filled in for you. Follow the instructions to complete and submit your enrollment.
Note: Some payers, such as the VA, Tricare, US Department of Labor, and Railroad Medicare, will be in the section labeled All or Multiple States Payer Enrollment Forms.