How To Complete Payer EDI Enrollment

How To Complete Payer EDI Enrollment

Some payers require providers to complete pre-enrollment before submitting electronic claims, example payers like Medicare and Medicaid.

Once your zHealth system is integrated with our clearinghouse partner, ClaimMD, you will be able to identify which payers require EDI enrollment directly within the system. You can then initiate the enrollment process electronically (if supported by the payer), or if the payer does not support electronic EDI enrollment, you will need to follow the manual enrollment process provided in the zHealth system.


How to Check if a Payer Requires EDI Enrollment


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1. Go to the Facility Settings and navigate to the Insurance tab in your account.


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2. Click the Edit icon located on the far right of the Payer Name. This will open a pop-up screen where the user can modify the payer details.


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3. Locate the "ClaimMD Payer ID" field and search for the appropriate payer using either the payer name or payer ID. Then, select the correct option from the dropdown list.
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Note: This step is essential to map the correct ClaimMD payer to the payer added in the zHealth Insurance Master. Once the correct ClaimMD Payer ID is mapped, the system will indicate whether the payer requires EDI pre-enrollment.


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4. In the Insurance master tab, the “Claim Submission” column indicates whether the payer requires EDI pre-enrollment.

Typically, in this column (Claim Submission), you will find the following:
  1. Not Available: This is typically shown in grey font, which means that the payer does not require enrollment.
  2. Available/Quick Enrol: This shows that enrolment is required and available, and can be completed instantly. No further action is needed from the practice or provider; simply submit the claims or check eligibility, and it will be processed automatically and instantly.
  3. Available/Enrolment: This shows that enrolment is required and available, and must be completed per the payer's instructions.
  4. Payer ID Missing: This typically shows that the insurance does not have the ClaimMD Payer ID mapped to it.


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5. Click the "Available/Enrollment" hyperlink to view EDI enrollment details and instructions. This will open a pop-up screen. From there, select the provider or facility from the dropdown under whose name you want to submit the claims electronically.


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6. Once you have selected the provider or the facility from the dropdown option, clicks the “Enroll” button, an enrollment page will open in a new tab or display the instructions. Review the instructions carefully and follow them as mentioned to complete the EDI enrollment process. Typically, the instructions include the following information:
  1. Where to fill in the EDI enrollment form
  2. Where to send the form
  3. How to check the status
  4. What to do once you have submitted the form
  5. Clearingouse ID (Identification Number)


Notes
For any questions related to EDI enrolment or claimmd, feel free to write to us at support@zhealthehr.com

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