Electronic (EDI) Claims Enrollment

Follow

Even if you are already credentialed with a payer, additional enrollment paperwork may need to be submitted in order to submit electronic claims to the payer via TherapyNotes. Accurately completing this paperwork ensures that your claims will be processed quickly and will help you avoid unnecessary claim rejections.

Prior to completing enrollments, ensure that the information you have entered in TherapyNotes exactly matches the information your payers have on file.

Role Required: Practice Biller

Enroll to submit electronic (EDI) claims

Most payers do not require enrollment in order to be able to submit claims electronically. For those that do require special enrollment, instructions for enrollment can be found in the payer's profile.

To determine the steps you must take to enroll for electronic claim submission with a payer:

  • Click Payers > Payer Name > Payer Info tab
  • Locate the section labeled Clearinghouse EDI Enrollment Status
  • Find the word Claims

The symbol that is shown next to Claims indicates the enrollment status for the payer.

A green check indicates that you are ready to submit electronic claims to this payer. This occurs if the payer does not require enrollment paperwork or if you have already completed the enrollment paperwork for this payer.

A yellow caution sign indicates that further action is required.

To begin the EDI claims enrollment process for a payer that requires additional paperwork:

  • Click anywhere on the section labeled Clearinghouse EDI Enrollment Status to edit
  • Select the Begin EDI Claims Enrollment checkbox
  • Click the Save Changes and Enroll button

You will see new information about the EDI claims enrollment process next to Claims. The EDI claims enrollment process may differ significantly between payers. Follow the instructions provided in the Clearinghouse EDI Enrollment Status box closely, or reference the types of EDI claims enrollments below.

Types of EDI Claims Enrollments

Type 1: Fax or Email Scanned Forms to TherapyNotes

Quick Tip: If there is a Change Healthcare cover page, TherapyNotes will automatically fill in as much of the form as possible for you. Prior to downloading the form, ensure that the information in your TherapyNotes account matches what is on file with the payer.

Type 2: Enroll Directly with the Payer Online

Type 3: Mail Original Forms with Physical Signatures to the Clearinghouse

Type 4: Change of Vendor Form

If you have converted to TherapyNotes from another EHR, you may have already been submitting claims through our clearinghouse, Change Healthcare. In this case, you would not need to complete the EDI Claims Enrollment process all over again. This will be indicated automatically in the payer's profile.

Type 5: External Enrollment

EDI Claims Enrollment Approval Process

TherapyNotes is often notified of approvals, and we will take the necessary steps to get you on your way to submitting electronic claims without further action from you. However, if you receive confirmation from a payer that you have been approved, please contact our support team to make sure they let us know as well.

Some payers will send you a confirmation number with your approval notification. Please make sure to provide this number to our support team, as it is required for them to complete your enrollment.

Tips for Completing the EDI Claims Enrollment Process

  • If you are asked for the trading partner ID (also known as the submitter ID or receiver ID), read What is the Trading Partner ID, Submitter ID, or Receiver ID? for help locating this information.
  • One of the most common reasons for rejected enrollments is a Tax ID or NPI mismatch. Make sure that the information used for enrollment exactly matches the information that your payers have on file.
  • Double check your work to ensure the forms are filled out completely. These forms are not created by TherapyNotes, they are made by the payers. Required fields may not be immediately visible and can result in rejected enrollments.
  • When submitting paperwork, include every page of the PDF you downloaded. Send in pages with just instructions as well as ones where you did not have to make any changes. Every page is required for processing.

When in doubt, contact our support team at (215) 658-4550, option 4. This will connect you directly to our enrollments specialist who will be able to help you with any questions you may have.

Payers that Do Not Support EDI Claims

Change Healthcare handles electronic claims to over 2,000 payers nationwide. However, if a payer does not have a valid payer ID in TherapyNotes, our clearinghouse cannot send electronic claims to that payer. Read No Payer ID to learn how to handle claims for payers without a payer ID.

Have more questions? Submit a request

Comments

  • Avatar
    Diana Moreland

    When claims are submitted through EDI do your offer any sort of support if there where an audit?

  • Avatar
    Rachael

    Diana,

    We do not offer support for audits, however we do offer support to find anything you may need within the system for the audit, including downloading your notes and files as well as viewing history and more. If you have further questions, please contact our Support Team at 215-658-450, or by email at Support@TherapyNotes.com. Thank you.