Electronic enrollment with insurance payers allows you to submit claims and receive electronic remittance advice (ERA) through Carepatron.
In this article, we will cover the following to set up electronic enrollments using our clearinghouse partner, Claim.MD:
What is an enrollment?
An enrollment is the process of notifying an insurance payer that you intend to:
Submit electronic claims
Receive electronic payment reports (ERAs)
Note: Some payers require enrollment only for ERAs, not for claim submission or eligibility checks.
Prerequisites
Before starting enrollment, make sure the following are complete:
1. You're credentialed with the payer
Ensure you've already been registered and credentialed with the payer outside Carepatron. Enrollments cannot be processed until you have completed the payer's credentialing process.
2. Import Claim.MD payers
Carepatron uses Claim.MD as our clearinghouse. Payers must be imported from Claim.MD into your workspace.
3. Set up billing profiles
Each practitioner or group must have a Billing Profile in Carepatron that includes:
National Provider Identifier (NPI)
Tax Identification Number (EIN or SSN)
These details are required to match your enrollment information with the payer’s records.
Enrolling for electronic claim filing
To submit claims electronically:
Go to Settings.
Click Insurance.
Locate the correct payer and click View.
The payer details will be shown, which includes the enrollments for all billing profiles.
Under Claim filing, select Enroll next to the billing profile to enroll.
Complete the enrollment form presented by Claim MD.
The status will change to Processing while the enrollment is being processed by Claim MD and the payer.
Once the enrollment is accepted by the payer, the status will change to 'Active', and no further action is required.
Enrolling for electronic payment reports (ERAs)
To receive ERA files:
Go to Settings.
Click on Insurance.
Click View for your chosen payer.
Under the Payment reports (ERA) section, click 'Enroll' next to the correct billing profile.
Complete the Claim.MD enrollment form.
Status will show as Processing.
When accepted, the status changes to Active.
Enrolling for eligibility checks
You can now request an eligibility and benefits report through real-time eligibility checks to help you verify a client’s insurance coverage before submitting a claim. This feature is available directly within Carepatron and integrated with ClaimMD.
Go to Settings.
Click on Insurance.
Locate the appropriate payer in the Payer list and select 'View'.
The payer details will be shown, which includes the enrollments for all billing profiles.
Under Eligibility, select Enroll next to the billing profile you would like to enroll.
Complete the enrollment form presented by Claim MD.
The status will change to Processing while the enrollment is being processed by Claim MD and the payer.
Once the enrollment is accepted by the payer, the status will change to 'Active', and no further action is required.
Read more about eligibility checks.
FAQs
What if my billing profile lacks an NPI or a Tax number?
If your billing profile is missing an NPI or a Tax number, it will appear as Incomplete and can't be enrolled.Do enrollments apply if practitioners use multiple workspaces?
For practitioners using multiple workspaces, an enrollment should apply to all workspaces that have a billing profile with the matching NPI and Tax number.Can claims be submitted for pending enrollments?
Yes, claims can be submitted for pending enrollments. However, enrollment documents will not be processed until approval has been received.Can I request eligibility reports while my verification is pending?
While providers are pending verification, requesting eligibility reports will fail.What if my enrollment is rejected?
If an enrollment is rejected, Carepatron will notify you of the reason for the rejection.Can I resubmit the form?
The enrollment forms can be resubmitted at any time to update enrollment details, allowing you to correct any errors and resubmit the enrollment to the payer.Why is my claim not being processed by a specific payer?
In some cases, Claim MD must verify provider enrollments separately. If you have recently enrolled with a payer for the first time, this verification may be pending.Why does my enrollment status appear incorrect in Carepatron?
In some cases, Carepatron does not receive enrollment updates from payers or the clearinghouse, and the enrollment status may not entirely reflect reality.What should I do if my enrollment or claim processing takes too much time?
If issues persist after a reasonable amount of time or claim processing is delayed, raise a support case.
Our team will be able to answer any other questions you may have. Just reply via messenger through the Help channel in your workspace.