1. EDI Enrollment Webinar for Practice Insight Authorized Resellers
Martha Johnson, Dir. Of Payer Development
Donna Anderson, Supervisor of EDI Enrollment
Jes Wettstein, EDI Enrollment Specialist
Jessica Moran, EDI Enrollment Specialist

2. Topics we will cover… EDI Enrollment- What IT IS, What IT IS NOT
Profiling your Customer
Managing the EDI Enrollment Forms (Claims/ERAs)
Tracking EDI Enrollment Requests
Avoiding EDI Enrollment Problems (Delays!)
Enrolling your customer for Real-Time Eligibility

3. EDI Enrollment: What IT IS, What it IS NOT.
EDI Enrollment IS:
a request by the provider made to a payer to allow the exchange of specific EDI transactions with that payer. The provider is already known to the payer.
EDI Enrollment IS NOT:
credentialing or registering the provider’s NPI# or Tax ID # with the payer.

4. 5 Types of ANSI Transactions
837 – Claims
835 – Remittance Advice (ERA)
270 - Eligibility Request
276 – Claim Status Inquiry
275 – Attachments (paperwork)

5. Profiling Your New Customer
Good questions to ask:
Single office or CBO?
Sharing Tax ID# with hospital or other office?
How many billing NPI#s tied to the Tax ID#?
For each payer, does the provider bill as a group or are the individual providers billing “solo”?
Professional claims and/or Institutional claims?

6. Profiling Your New Customer
First things first!
Login to EDIinsight
Add the NEW CUSTOMER ACCOUNT
Get the basics input to the account:
Name, Address, Tax ID#

7. Profiling Your Customer
Add the Provider Records in EDI Customer Account:
Provider Name, Address
Person or Non-Person?
Billing or Rendering?
NPI#
Tax ID#
Taxonomy (Specialty) Code
Medicare PTAN#, Medicaid ID#

8. Profiling Your Customer…
Create a Payer Inventory List
Build a list of your Customer’s Top Payers
Make a list of government payers your customer needs: Medicare Part A/B, DMERC, Medicaid, BCBS, Railroad Medicare, Tricare
Make a list of commercial payers your customer needs: Aetna, CIGNA, Humana, United Healthcare, commercial Medicaid Managed Care plans (MCO)

9. Profiling Your Customer
Create a Payer Inventory List
Build a list of Payers that currently send Electronic Remits to your Customer.
Note how each ERA is delivered to your Customer: Clearinghouse, Provider/Web Portal, other direct delivery to Customer
Add to the list any additional Payers from which the Customer would like to have Electronic Remittance files.

10. Profiling Your Customer
Create a Payer Inventory List
Compare the inventory list to the Practice Insight payer list and look for gaps.
Pay attention to Professional vs. Institutional.
If payer is not found, contact us with your request, including payer ID# (log an Issue or

11. Time to Play Whose Enrollment is it Anyway?
1st Question
Name / Describe 2 types of ANSI transactions that we have discussed.
Answer:
837 (Claims), 835 (ERAs), 270 (Eligibility), 275 (Attachments), 276 (Claim Status)

12. Whose Enrollment is it Anyway?
2nd Question
What should you do BEFORE your customer submits any EDI enrollment paperwork to payers?
Answer:
Set up customer in EDIinsight.
Add customer and provider record(s).

13. Whose Enrollment is it Anyway?
3rd Question
What is a good question you can ask your new customer to learn about how they file claims?
Answer:
Single Office or CBO? Do you share tax ID # with another office? How many billing NPI #s in your office? Do your providers bill as a group or as individuals, and for which payers? Do you bill professional, institutional or both?

14. Where are the forms?
Web page where Practice Insight keeps library of EDI enrollment documents:
(This site is for Resellers, not Providers!
Go ahead and bookmark this URL.)

15. Fill Out EDI Enrollment Forms for Each Billing Provider
Who is the Billing Provider for this Payer?
What NPI# is used to bill this Payer, e.g, group NPI# or individual provider’s NPI#?
Is there more than 1 Billing Provider/NPI?
Address should match credentialing at Payer
Signatures must be Authorized
If any question about how the Customer is billing the Payer, CALL the Payer and Ask!

16. Fill Out EDI Enrollment Forms Electronic Remits
Payers typically deliver ERA files to one trading partner only at a time—no duplicate delivery
Once enrolled, Payer will send ERA files for all payments, whether the claim was submitted by Practice Insight or not
Changing existing ERA authorization may require additional LOA (letter of authorization) on provider letterhead—check PI instruction page
ERA delivery to EDI Customer account depends on complete and accurate input of provider Tax ID and NPI numbers

17. What if I don’t find forms?
Government Payers
No forms? Contact enrollment department.
Govt. Payers require 6-10 weeks to develop a new direct connection and approval to submit claims or a new transaction type.
Electronic Remits must also be developed or contracts negotiated for Practice Insight to register and deliver these files
Questions? Create an issue.
**Distinguish between Professional vs. Institutional
Example: Medicare Part A and Medicare Part B
PI may need to test with Medicare Part A “Institutional”

18. Managing the EDI Enrollment Forms
Always download a current set of payer enrollment forms (Refer to Reseller Docs URL)
Distribute Forms to Customer (Do not give out URL)
Ideal time frame- 30 days before the go-live date (forms do change)
Always check PI instructions for how to deliver forms
Always make a copy of the completed enrollment form

19. Tracking EDI Enrollment Requests
PI will share with Reseller any Payer confirmations or rejections (usually by )
Some payers send NO notification to Practice Insight or to the provider
Reseller can follow-up with payer
Call with your copy of forms in hand—Payers often ask for Provider NPI, Tax ID or legacy PIN

20. Time to Play Whose Enrollment is it Anyway?
1st Question
What instructions should you refer to when completing and submitting EDI enrollment forms?
Answer :
The “Practice Insight” instruction page that precedes each set of EDI Enrollment Forms posted to the PI Reseller Forms’ Library.

21. Whose Enrollment is it Anyway?
2nd Question
If the Customer’s Go-Live date is February 1st, what date should you target to send completed forms to the payers?
Answer :
January 1st. Allow approx. 30 Days. Enrollment varies from payer to payer. (ERA setups can take longer, 4-6 weeks.)

22. Whose Enrollment is it Anyway?
3rd Question
When following up on an EDI enrollment request, what should you have in front of you?
Answer :
Copy of the completed forms submitted to the payer. It’s also helpful to know the date the request was submitted.

23. Avoiding EDI Enrollment Problems
Top 5 “Action Needed” (From Practice Insight):
Top 5 Rejections (From Payer):
Missing Signature
Missing NPI or TAX ID
Nothing Selected on Form
Missing Valid Billing Address
Illegible
Enrolling w/ wrong PTAN (Individual vs. Group)
Provider Not Credentialed
Unauthorized Signature
Missing PTAN, Legacy, etc.
Didn’t Select Change CH

24. Avoiding EDI Enrollment Problems
Always download the latest documents
Assist your customer
Proof read NPI numbers and Tax ID numbers
Make sure no missing signatures

25. Special Notice for Private Databases
Some Authorized Resellers have a Private Database with DIFFERENT SUBMITTER INFORMATION than standard Practice Insight accounts.
If so, Reseller must modify standard EDI enrollment documents.
Check with PI Enrollment Dept. for help.

26. Enrolling your Customer for Real-Time Eligibility
Go to PI’s Provider Enrollment Steps web page at
Click on the link RT Eligibility forms which will take you to the Real Time Eligibility web page at
Click on Practice Insight 270/271 Eligibility Registration to open the form to complete and submit your customer’s enrollment request.

27. Enrolling your Customer for Real-Time Eligibility
Payers that DO require Eligibility Enrollment:
CMS Medicare including all Medicare A/B, Railroad Medicare and DMERC.
Special Payers – these are found on the PI web site, along with forms and instructions.

28. Enrolling your Customer for Real-Time Eligibility
Payers that DO require Eligibility Enrollment:
Complete Practice Insight 270/271 Registration Form for each customer.
For any Special Eligibility Payers, go to the RT Eligibility web page to access Payer form.

29. Time to Play Whose Enrollment is it Anyway?
1st Question
If your customer requests a payer and it is not on the EDI payer list, what should you do?
Answer:
Contact PI’s EDI Enrollment dept. Log an issue in Issue Manager, call the Enrollment Dept, or send to Be sure to include the electronic payer id (usually 5 digits) and any information you have about the payer.

30. Whose Enrollment is it Anyway?
2nd Question
Give 2 or more reasons why an EDI enrollment request might be rejected or delayed.
Answers:
Missing signature. Illegible. Missing or Invalid Provider Numbers, e.g, such as Provider ID #, PTAN # NPI #, Tax ID #. Incorrect Provider name. Individual provider information on form instead of billing provider group information.

31. Whose Enrollment is it Anyway?
3rd Question
How will you know when your customer is enrolled and can begin submitting claims?
Answer:
Watch for an , fax or letter from the payer. You (the PI Reseller) may receive a CONF from Practice Insight. You or your customer can call the payer to get verbal confirmation that the provider is approved to submit claims via Practice Insight.

32. In Summary…
Take the time to PROFILE YOUR CUSTOMER to get a complete and accurate assessment of the customer’s EDI enrollment requirements.
SETUP THE CUSTOMER IN EDI (add customer record and provider records) BEFORE SUBMITTING EDI Enrollment paperwork.

33. In Summary… Support your provider -- they need your help!
Assist your customer in completing and reviewing EDI enrollment forms. (Rejected EDI enrollments create unnecessary and painful delays!)
EDI enrollment can be part of your implementation services and fees

34. In Summary…
Manage your customer’s expectations about length of time to complete enrollments and when they will be ready to “go live” with EDI.
Track the EDI enrollments so that you are aware of rejections and confirmations as soon as possible.

35. In Summary…
Monitor the first batch of claims your new provider sends to Practice Insight –react quickly to claim rejections.
Making your customer’s first experience positive with EDIinsight can be critical to your success. Customers always remember whether the start-up was smooth or rocky!

36. In Summary…
As with all EDIinsight issues, contact Practice Insight when you need help.
To reach PI’s Enrollment Dept…
Log an issue in Issue Manager
Send to
Call (press Option #2) \

37. 1st BONUS QUESTION!!!! What is an ERA? Answer:
Electronic Remittance Advice (electronic eob)

38. 2nd BONUS QUESTION!!!! What is a EFT?
Answer:
Electronic Funds Transfer (monies deposited in bank)

39. 3rd BONUS QUESTION!!!!
What is the difference between an ERA and an EOB?
Answer:
ERA is received via electronic file. EOB is received on paper.