Understanding Basics of EDI Enrollment

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Understanding Basics of EDI
Enrollment
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Understanding Basics of EDI Enrollment
Basics of EDI Enrollment The introduction of the
electronic claim submission process has changed
medical billing and the overall healthcare
industry forever. The system of paper claim
management was filled with inefficiencies and
inaccuracies. For providers looking to eliminate
these problem areas in their claims process, EDI
enrollment is necessary. Electronic Data
Interchange (EDI) is an innovative digital
communication tool that is used to deliver data
from a provider to a payer. In order to be
eligible to submit electronic claims to private
or government payers, providers must complete EDI
enrollment. Until you have completed all
necessary registration processes, you wont be
able to submit electronic claims to that
insurance agency. While some payers are still
accepting paper claims most of them wont allow
the submission of paper claims at all. In a
perfect world, providers would only have to
complete a few documents and distribute them to
all payers, but this is not the case. Providers
work with dozens of insurance companies who each
have their own list of requirements. It becomes
obvious that EDI enrollment quickly becomes
overwhelming to a healthcare organization that
works with more than one or two payers. Each
insurance carrier has different procedures and
requirements to qualify for EDI. Note that before
registering for EDI enrollment, you have to
complete all steps in the provider enrollment
process.
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Understanding Basics of EDI Enrollment

• EDI Enrollment and Medicare
• The Centers for Medicare Medicaid Services
  (CMS) standard Electronic Data Interchange (EDI)
  enrollment form must be completed prior to
  submitting Electronic Media Claims (EMCs) or
  other EDI transactions to Medicare. The agreement
  must be executed by each provider of health care
  services, physician, or supplier that intends to
  submit EMC or use EDI, either directly with
  Medicare or through a billing service or
  clearinghouse. Each new EMC biller must sign the
  form and submit it to their local Medicare
  Administrative Contractor (MAC) or Durable
  Medicare Equipment (DME) MAC. Any healthcare
  organization comprising multiple components that
  have been assigned Medicare provider numbers,
  supplier numbers, or UPINs may elect to execute a
  single EDI Enrollment Form on behalf of the
  organizational components to which these numbers
  have been assigned. The organization as a whole
  is held responsible for the performance of its
  components. You can refer the Medicare Claims
  Processing Manual (Pub.100-04), Chapter 24, and
  Sections 30 30.4 for detailed information.
• Top EDI Application Errors
• While working with various providers, we observed
  the following top EDI application errors
• Application submitted without the Group PTAN
  Accurately list your group PTAN and NPI along
  with the individual PTAN and NPI
• Duplicate application requests This may happen
  when you submit a new application while the
  previous one is under process.

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Understanding Basics of EDI Enrollment

• Please allow at least 20 business days for
  processing the application.
• Incomplete applications or agreements Fill in
  all the relevant areas on the application form.
• Invalid PTAN or submitter ID listed on EDI
  application A Submitter ID number is a unique
  number identifying electronic submitters. EDI
  applications cannot be processed without a valid
  PTAN and Submitter ID
• No signature attached EDI applications cannot be
  processed if the signature page is not completed
  or missing.
• Accurately Submitting EDI Application
• Even though each payer has their unique
  application form, the following guidelines would
  be helpful in accurately submitting an EDI
  application
• The EDI enrollment form should be submitted when
  enrolling for electronic billing. You need to
  complete the provider enrollment procedure prior
  to filling EDI enrollment application.
• Please ensure that you include your Medicare
  Provider Number and National Provider Identifier
  (NPI) where requested on the EDI Enrollment Form.
• If the submitter will be submitting for multiple
  providers, this form must be completed by each
  provider whose claim data will be submitted. If a
  provider is a member of a group, only one
  agreement per group is required.
• EDI applications should be reviewed and signed
  only by the providers to ensure each provider is
  knowledgeable of the enrollment request and the
  associated requirements. You must notify payers
  in case of any changes in their billing agent or
  clearinghouse. Also update payers the effective
  date of which the provider will discontinue using
  a specific billing agent or clearinghouse.

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Understanding Basics of EDI Enrollment

• Providers that have contracted with a third party
  (clearinghouse/network service vendor or a
  billing agent) are required to have an agreement
  signed by that third party in which the third
  party has agreed to meet the security and privacy
  requirements that apply to the provider.
• Legion Health Care Solutions is a leading medical
  billing company that can assist you in revenue
  cycle functions for your practice. We can assist
  you in completing all processes required for
  electronic claim submission including EDI
  enrollment for all applicable payers. To know
  more about our provider credentialing
  enrollment services, contact us at 727-475-1834
  or email us at info_at_legionhealthcaresolutions.com

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