Our team manages all payers’ EDI, ERA, and EFT Enrollments:

  • EDI (Electronic Data Interchange) : Ensuring timely and accurate setup for electronic claims submissions to all payers.
  • ERA (Electronic Remittance Advice) : Enrolling providers to receive standardized remittance files to streamline posting and reconciliation.
  • EFT (Electronic Funds Transfer) : Managing enrollment to facilitate direct deposit of payer reimbursements, improving cash flow and reducing processing time.

Payer Enrollment Management – EDI, ERA, EFT (Detailed Overview)

Objective :

To ensure seamless and compliant electronic communication and payment processing between providers and payers by managing all aspects of EDI, ERA, and EFT enrollment.

EDI (Electronic Data Interchange) Enrollment :

Purpose :

To enable electronic submission of healthcare claims and other transactions (eligibility, claim status, referrals) between providers and payers.

Key Responsibilities:

  • Payer Requirements Research : Identify payer-specific EDI enrollment requirements, including forms, documentation, and clearinghouse involvement.
  • Form Completion : Prepare and submit enrollment forms for claim submission and real-time transactions (270/271, 276/277).
  • NPI & TIN Validation : Ensure correct NPI, TIN, taxonomy codes, and billing addresses are provided.
  • Clearinghouse Coordination : Liaise with clearinghouses (e.g., Availity, Change Healthcare, Office Ally) to submit EDI enrollments and monitor status.
  • Follow-up & Confirmation : Track submission status, address rejections, and obtain confirmation when EDI is active.

ERA (Electronic Remittance Advice) Enrollment :

Purpose :

To receive remittance details electronically, enabling automatic or simplified posting and reconciliation in the provider’s practice management system (PMS) or EHR.

Key Responsibilities:

  • Enrollment Initiation : Submit ERA enrollment requests to each payer, often through payer portals or clearinghouses.
  • Form Accuracy: Ensure provider information (NPI, TIN, payer ID, etc.) is consistent with clearinghouse and payer systems.
  • Banking Info for Matching: Coordinate ERA with EFT setup to ensure ERA/EFT linkage (sometimes required by payer).
  • EHR/PMS Integration: Confirm ERA file delivery is compatible with the provider’s system and testing is complete.
  • Monitoring: Track rejections or delays and follow up until active status is confirmed.

EFT (Electronic Funds Transfer) Enrollment :

Purpose :

To allow electronic deposit of insurance payments directly into provider bank accounts.

Key Responsibilities:

  • Secure Information Handling: Collect banking details securely (voided checks, deposit slips, W-9) and comply with HIPAA/PCI regulations.
  • Form Submission: Complete and submit EFT forms, often requiring notarization or bank letter for verification.
  • Payer-Specific Processes: Follow payer-specific methods (portal, fax, mail) and requirements.
  • Activation Confirmation: Verify test deposit or first EFT transaction to confirm setup success.
  • Ongoing Maintenance: Manage updates due to bank changes, mergers, or provider demographic changes.

Our Best Practices :

  • Maintain a centralized tracking system for all enrollments (e.g., Smartsheet, Excel).
  • Use a payer contact directory to streamline follow-up.
  • Schedule regular audits to verify active EDI/ERA/EFT status.
  • Keep a knowledge base or SOP manual updated with payer-specific instructions and FAQs.