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.
Under the Claim filing section, find your billing profile and click Enroll.
Complete the Claim.MD enrollment form.
The status will show as Processing while it's reviewed
Once accepted, the status will change to Active – you're ready to file claims!
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.
Troubleshooting enrollments
If an enrollment is rejected, Carepatron will notify you of the reason for the rejection.
You can resubmit the form at any time after fixing the issue.
If your billing profile is missing an NPI or Tax number, it will appear as Incomplete and can't be enrolled.
In some cases, Claim.MD or the payer may not return enrollment status updates. If this happens and you're blocked from submitting a claim, please contact Support.
Claims can still be submitted while an enrollment is processing.
If you're part of multiple workspaces, enrollments will apply to all workspaces that use the same NPI and Tax number.
Our team will be able to answer any other questions you may have. Just reply via messenger through the Help channel in your workspace.