Some payers require EDI approval in order to submit claims electronically. If you submit claims by print and mail, you do not need to complete enrollment.Typically, only two or three insurance companies per state require EDI enrollment, but Medicare always requires enrollment.
Enroll with the NPI that is on file with the payer. Depending on how you were credentialed, this can be either your default billing provider NPI, or a rendering provider NPI. 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 electronic claims to a worker's compensation agency or auto insurance company, you will need to use the Jopari clearinghouse. Click here for more information about the Jopari Clearinghouse.
All insurance companies require ERA approval before they send electronic remittances. Until your clinic has enrolled and received approval from an insurance company, you will receive paper EOBs.
Enroll with the NPI that is on file with the payer. Depending on how you were credentialed, this can be either 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 electronic 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 email@example.com:
- Enrollment type (EDI, ERA, or EDI and ERA)
- Payer name and payer ID
- Billing NPI (with indication of group or inpidual)
- Tax ID
- PTAN (Medicare only)
- Submitter ID/Payer-issued provider number (if applicable)
Madaket (our EDI and ERA enrollment vendor) will contact you if signatures are required to complete enrollment. Promptly return any newly-signed forms to expedite the approval process