EDI approval is required by some payers in order to submit claims electronically. If you will be submitting claims by Print & Mail, you will not need to complete enrollment. While only about 2-3 insurance companies per state require enrollment, Medicare always does.
Use the NPI that is on file with the payer. This can be your default billing provider NPI or a rendering provider NPI, depending on how you were credentialed. Each billing provider NPI must have an EDI enrollment on file in order to submit claims.
If you already use Availity as your clearinghouse, you do not need to re-enroll for EDI.
Note: If you want to submit claims electronically to a Worker's Compensation or Auto insurance, you will need to use the Jopari clearinghouse. For more information, please see: Jopari Clearinghouse.
ERA approval is required by all insurance companies to begin receiving electronic remittances from a payer. Until your clinic has enrolled and received approval from the insurance company, you will receive paper EOBs.
Use the NPI that is on file with the payer. Depending on how you were credentialed, this can be your default billing provider NPI or a rendering provider NPI. Each billing provider NPI must have an ERA enrollment on file in order to receive remittances.
If you already use Availity as your clearinghouse, you must re-enroll to continue receiving ERAs.
Note: Requesting ERA enrollment is not an indication that you will receive ERAs. Not all payers offer ERAs.
To enroll in EDI and/or ERA, submit the following information to firstname.lastname@example.org:
- Enrollment Type: EDI, ERA, or EDI & ERA
- Payer Name & Payer ID
- Billing NPI (indicate Group/Individual)
- Tax ID
- PTAN (Medicare Only)
- Submitter ID/Payer-Issued Provider Number (if applicable)
If necessary, Madaket (our EDI/ERA enrollment vendor) will contact you if signatures are required to complete enrollment. Return signed forms promptly to ensure approval.