Change Healthcare: EDI / ERA Enrollments

Change Healthcare EDI/ERA Enrollments approval is required by some payers in order to submit claims electronically. If you will be submitting paper claims for the payer, you will not need to complete enrollment. While only about 2-3 insurance companies per state require enrollment, Medicare always does.

Your EDI/ERA enrollments must be completed on the Change Healthcare clearinghouse portal.

Once you complete the enrollments you will be able to view a copy of the enrollments that have been requested, as well as print the documentation for submission to each insurance. Enrollment paperwork requirements vary by insurance. 

EDI / ERA Enrollment Steps 

1. Once you are logged in to the portal, navigate to Tools and Setup. Under the enrollments column, select Providers.

2. Click the Search button to select the provider.

3. In the enrollments column, click New. 

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   Select Payers and Transactions 

   The next step will display each insurance that is available within Change Healthcare. We recommend using the Payer ID to narrow your search. The state filter option is helpful for government-type insurances, but not recommended for other payers like Aetna. Please keep in mind that some insurance companies have multiple Payer IDs. 

4. Check the box in the 837 (EDI File) columns for each of the insurance companies you would like to enroll with. You can select multiple payers on this page. 

5. Important: We do not recommend checking the ERA box until you are within a week of your Go Live Date. This reduces the number of ERAs appearing in WebPT Billing that actually belong in your previous billing system. Also, when you are in the process of generating forms it will ask for contact information. Feel free to update the default contact for that enrollment if needed.

   

6. Select Continue to Next Step once you have made the selections. You may be instructed to review the four tabs on this screen before you can move on again. Please keep in mind that some government payers may require PTANs and Provider Numbers to be filled out in the Incomplete Enrollments tab.

7. Once you have reviewed each tab, select Continue to Next Step. 

8. You will receive a confirmation message. Click the link to  review the agreement.

9. Click the View/Print ALL button in order to view the enrollment form. There will be a downloaded file to open at the bottom of your screen.

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   Payer Enrollment Instructions & Forms

   Payer Enrollment Instructions 

   Each insurance company provides specific instructions on how to complete and submit these forms. These instructions will vary by payer. Please review Steps 1-3 on the PDF for key information about the enrollment process and requirements.
   

   Enrollment Forms

   Your enrollment forms will be attached to the Payer Enrollment Instructions. Some pages will have pre-populated information. You must complete the enrollment forms. Once they are completed, please submit them to the insurance and clearinghouse as instructed in the enrollment instructions and or on the enrollment forms themselves. If you need assistance with the enrollment forms, we recommend that you contact the insurance for any clarification of the forms. 

Enrollment Status

Once you submit the documentation as instructed, you can view the enrollment status information in the Change Healthcare Portal. 

1. Go back to Tools and Setup, and select Providers.
2. Click Search, select View in the enrollments column.
3. This screen will list each enrollment that has been selected. Click the Enroll ID. You will be given one for each payer enrollment.

Enrollment Details 

Change Healthcare will update the status of the enrollments once the approval has been received. If you need to follow up with payers for a status update, Change Healthcare will alert you.

In the Workflow Information section, the Check Point drop-down shows the status of the enrollment. The Check Point will also show up when you “view” the enrollment and you will be able to see the status at a glance.

Enrollment Identifiers

Please update the enrollment status for the payers that Change Healthcare cannot update on your behalf. Change Healthcare will automatically update the status for the enrollments that they can. For any enrollments that are unable to provide a status update, you will receive a message in the Enrollment Identifiers section. Contact those payer's enrollment departments directly, and then update the Check Point of the enrollment. 

Note: If the Check Point status is not updated, it will delay claim submissions and/or ERA retrieval.

We also recommend using the Notes section to keep track of any enrollment statuses or actions taken pertaining to the enrollment.