Enrollments FAQs

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Updated: 09/01/2023 | Views: 9568

Answers to the most common Electronic Data Interchange (EDI) enrollments questions.

General Enrollment Process FAQs

Question	Answer
What is Electronic Data Interchange (EDI) enrollment?	Electronic Data Interchange (EDI) enrollment is the process where the provider/practice completes the setup to submit EDI services to a specific payer via a clearinghouse.
What EDI services are available and require enrollment?	The following EDI services are available and may require enrollment: Electronic Claim submission Electronic Remittance Advice (ERA)/ Electronic Funds Transfer (EFT) reports Real-Time Eligibility (RTE) checks
What are the enrollment requirements to use Tebra?	There are three steps that must be met. Tebra/Clearinghouse Setup: This is completed through the Enrollments Dashboard. Here, you add your electronic insurance connections and submit enrollment requests. This initiates the process to generate the insurance specific steps. Insurance Registration: This is the enrollment piece required by each insurance. It can be a form that must be signed, an email, an online web form, or an online portal that requires a username and password. Insurance Approval: Once the enrollment is submitted to the insurance, the insurance processes the request and either approve or deny it. When possible, Tebra Enrollments follows up with the insurance for updates.
What information do I need to provide for enrollments?	It is very important that you provide accurate information to assist with enrollments. Payers deny requests if the information submitted does not match what they have on file. Verify the following information with the payers prior to submitting enrollments: Practice name Practice address Tax ID/NPI Provider numbers if applicable Authorized contact signer
What is a group/individual provider number and where can I find it?	Group or individual provider numbers are assigned by the payer when you are credentialed. This number can be found on your credential paperwork or by contacting the payer directly. Payers will not release group or individual provider numbers to Tebra.
What happens if I am not credentialed with an insurance company?	If enrollment is required, you cannot use electronic services with that insurance. Enrollment requests are submitted to insurances with the information you enter in the Enrollments wizard. The insurance attempts to match the request to a record in their system. If a matching record is not found, the request may be denied. To ensure your request is processed correctly, contact the insurance in advance and confirm your Tax ID and NPI are on file.
Why can’t I find a specific insurance company?	The most common reasons why an insurance company may not be found are: The insurance plan name was entered instead of the insurance company name. For better results, search by the company name. The insurance company does not accept electronic claims. The insurance company does not have a direct connection with Tebra's clearinghouses. Some insurance companies have exclusive vendor relationships and are not able to work with other clearinghouses.
What is the difference between clearinghouses?	Trizetto Provider Solutions’ network is composed of primarily medical insurances for both professional and institutional services. Jopari Solutions’ network is composed of primarily worker’s compensation and auto insurances. These insurances will typically require attachments sent with the claims and Jopari offers this functionality.
When I submit a request, how will Tebra Enrollments contact me?	Tebra Enrollments sends emails to the contact provided in step 5 of Enrollments wizard. If you are the main point of contact for enrollments, be sure to enter your valid and up-to-date contact information.
What is the next step after submitting my enrollment request?	Tebra Enrollments identifies the necessary forms and instructions for each insurance enrollment submitted and will reach out to you as needed. For more information about enrollment statuses, review Enrollment Status Indicators.
How do I find out what is needed from me if the status says “Action Required”?	Check your email for additional information from Tebra Enrollments. Reasons for a "Action Required" status include missing information, instructions for you to complete, or agreements for you to sign and return. Note: Emails are sent to the contact provided in step 5 of Enrollments wizard.
Why can’t Tebra enroll me in everything?	Enrollments is a lengthy and involved process that requires action from you as well. We want to ensure your success by focusing on the insurances you actually see patients for and bill claims to regularly. Selecting irrelevant insurances may cause unnecessary work for you to complete. In addition, insurances that you aren’t credentialed with will deny for invalid provider.
If the provider is migrating from one account to another, does the provider have to re-enroll for electronic services?	Enrollment for electronic services is based on the provider’s Tax ID, Billing NPI, and clearinghouse. If any of the three have changed, enrollment paperwork may be necessary to update the information on the payer's system.
Does a new provider in an existing practice need to enroll with our established insurance companies?	If the provider’s claims are billed with the same Group NPI, they do not need to enroll with Tebra or the clearinghouse(s). However, you must make sure the provider has been updated/credentialed with all insurances and linked to your Group NPI. If the provider’s claims are billed with their own Individual NPI only or a different Group NPI, they need to enroll with Tebra or the clearinghouse(s).
Do I need to re-enroll if I have a new Tax ID or Group NPI?	Yes. All affected insurances need re-enrollment for electronic services. Update your Practice/Provider settings and complete the Enrollments wizard.
The insurance sent me a blank agreement to complete enrollments. How do I fill this out?	Email enrollments@tebra.com for assistance in completing the agreement, otherwise, you may not be set up correctly with the insurance.
The insurance is sending me information to re-enroll. Do I need to do this?	Insurances continually improve their technology solutions. This may require you to re-enroll to continue submitting claims and receive ERAs. Contact the insurance for more information. If Tebra is notified of any large scale changes by our clearinghouses, we will inform you as well.
What is a Trading Partner ID or Submitter Number?	The clearinghouse that has the direct insurance connections are assigned unique identifiers by each insurance. If you need this information, contact Customer Care for assistance.
What is Tebra’s Trading Partner ID or Submitter Number?	Since Tebra does not have any direct insurance connections, we are not assigned any Trading Partner IDs or Submitter numbers.
Why is the status “Enrollment Required” when it was approved a long time ago?	Due to a change in enrollment processes, active insurances that were enrolled prior to late 2013 may display status "Enrollment Required" on the Enrollments Dashboard (when it is actually approved).

Claims Enrollment FAQs

Question	Answer
Is it possible for providers to submit claims using multiple vendors/clearinghouses for the same insurance?	Sometimes. Most insurances allow dual submission, meaning a provider can submit claims via multiple vendors/clearinghouses to the same insurance, but there are some insurances that only allow a set amount of submitters (e.g., 1 to 5 submitter limits). Contact the insurance to confirm dual submission is possible.
What is a UB insurance?	“UB” in the name of an insurance indicates the connection is specific to Institutional (UB-04) claim billing. Only select if this applies.
How long does it take to receive payer approval for claims enrollment?	Each payer has their own processing time that typically ranges between one to eight weeks.
Why was my claim enrollment denied?	Once payers receive enrollment requests, they review the requests for a matching provider in their system and accurate completion. The most common reasons for denied claim enrollments are: Invalid provider: Tax ID and NPI does not match any records in the payer system. Mismatched information: Practice name submitted on request does not match what is on file. Mismatched information: Address submitted on request does not match what is on file. Agreements signed by an unauthorized contact who is not on file. Missing information on the forms, such as a notary stamp or business titles. Note: Tebra Enrollments will email you the information about the enrollment denial and what is needed if the payer will disclose the information. Otherwise, you need to contact the payer directly.
The enrollment status is “Approved", so why am I not able to submit claims?	Once a payer enrollment status shows "Approved" on the Enrollments Dashboard, it’s important to review the Insurance Company record and verify the settings are properly configured. Insurance Company Electronic Claims and Practice Settings that are not properly configured may prevent claim submission or result in claim rejection or delayed payment.

ERA/EFT Enrollment FAQs

Question	Answer
What is an Electronic Remittance Advice (ERA)?	An ERA is a payer remittance file that Tebra can receive to help you quickly post payments and manage your account receivables.
Can I receive ERAs through multiple vendors/clearinghouses?	Payers only authorize one vendor/clearinghouse to receive ERAs. If you have split your billing between two vendors/clearinghouses, you must choose one that receives ERAs for your Tax ID/NPI.
How long does it take to receive payer approval for ERA enrollment?	Each payer has their own processing time that typically ranges between two to eight weeks. It is recommended you maintain your current software to get access to ERAs until everything is transitioned. You must send claims for ERAs to be generated and delivered.
Why was my ERA enrollment denied?	Once payers receive enrollment requests, they review the requests for a matching provider in their system and accurate completion. The most common reasons for denied ERA enrollments are: Invalid provider: Tax ID and NPI does not match any records in the payer system. Mismatched information: Practice name submitted on request does not match what is on file. Mismatched information: Address submitted on request does not match what is on file. Agreements signed by an unauthorized contact who is not on file. Missing information on the forms, such as a notary stamp or business titles. Incomplete enrollment: Request was not validated by provider. Note: Tebra Enrollments will email you the information about the enrollment denial and what is needed if the payer will disclose the information. Otherwise, you need to contact the payer directly.
Why is the payer contacting me to verify if ERAs should be changed?	Some payers reach out by phone or email to validate the change request. Failure to respond timely can delay your request or result in denial of the request.
What is an Electronic Funds Transfer (EFT)?	An EFT is a direct deposit of funds from the payer to the provider's bank account. Not all payers offer EFT and some payers require EFT with ERA enrollment.
How do I enroll for EFT?	EFT enrollment is completed between the provider and the payer. Contact the insurance directly for EFT enrollment instructions. However, if the insurance requires EFT with ERA enrollment, Tebra Enrollments will provide the EFT enrollment information to you.
I’m setting up EFT and I need the Trading Partner ID or Submitter Number.	Email enrollments@tebra.com for assistance, otherwise, you may not be set up correctly with the insurance.
Why am I missing an ERA file?	It is not uncommon for ERA files to be delayed in delivery due to technical issues. If you determined that you do not have an ERA file for a payment dated within 45 days, follow the steps below to submit a Missing Electronic Remittance Inquiry Request: Click Encounters > Clearinghouse Reports. The Find Clearinghouse Report window opens. Click Missing Electronic Remittance Inquiry Request. The Missing Electronic Remittance (ERA) Inquiry page launches in a web browser. Follow the prompts to submit a Missing ERA inquiry.
Why did my ERAs stop coming in?	The most common reason ERAs stop being delivered to your account is inadvertent changes made to your electronic profile with the payer. For example, contacting the payer to elect into their portal delivery or signing up with another software, even for a trial, and submitting enrollments can change your electronic profile. Re-enrollment is required.

Eligibility Enrollment FAQs

Question	Answer
What is a Real-Time Eligibility (RTE) check?	Tebra offers real-time patient eligibility checks if the payer supports it. This enables you to confirm patient health coverage. Most payers do not require enrollment to check patient eligibility.
How will I know if I must enroll for eligibility?	Once you add an insurance, the Enrollments Dashboard displays the status for each service. If enrollment is required, status “Enrollment Required” displays.
I am approved for eligibility. Why is it not working?	The most common reason for eligibility not working is invalid information. Verify the patient and guarantor information was entered correctly and that you are sending the request to the correct payer. For further assistance, contact Customer Care.