Waystar: EDI/ERA Enrollments

Waystar 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 in the Waystar portal.

In this article, we'll cover how to Create a New Enrollment Request and Check Enrollment Status.

Create a New Enrollment Request 

  1. Once you are logged in to the portal, start by going to the Account tab. 
  2. On the Account page, click the Enrollment tab.
  3. From the action menu, select Dashboard
  4. On the Dashboard page, click Create.
  5. On the New Enrollment Request(s) page, enter the required information:
    1. In the Account section, select the Account from the drop-down list. 
    2. In the Applications section, select the Professional Claims and/or Institutional Claims checkbox for EDI enrollments (837). Select the Remits checkbox for ERA enrollments (835).  Important: We do not recommend checking the Remits checkbox 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.
    3. In the Add Payers section, select each of the insurance companies you would like to enroll with. You can select multiple payers on this page. 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. In the Add Providers section, enter the Provider name(s) or NPI number(s). You can add up to 10 providers.
    5. Click the Generate Request(s) button to complete your enrollment requests and print the forms. 
Payer Enrollment Instructions & Forms

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

The actual 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. 

Mass Uploading

To further expedite the enrollment process, Waystar also offers the ability to mass upload enrollment requests using a standard Excel spreadsheet. For complete instructions on how to do this, check out the Enrollment Quick Start Guide

Check Enrollment Status 

Some payers may take 30 days or longer to approve an enrollment, while other may take 5 days or less. During this approval process, Waystar will follow up with your payer at the appropriate times. You can check Waystar for the status of the request and act accordingly depending on what phase the request is in.  

  1. Once you are logged in to the portal, start by again going to the Account tab. 
  2. On the Account page, click the Enrollment tab. 
  3. Under the Enrollment menu, click the Manage Requests dropdown and select Requests

All outstanding enrollment requests will display. The Application column will identify the type of enrollment request that was made (EDI or ERA), and the Phase column will tell you what phase the request is in. Actionable links will be highlighted red as is the case with the Provider Action Required shown here. Please reference the Enrollment Phase Definition table below for definitions of each phase. 

When you hover over an enrollment request, the line will be highlighted blue and action buttons will appear below the line. These buttons allow you to Edit the request, add Notes to the request to document your actions, Download a copy of the enrollment request, review the History of the request, and Cancel the request.

Edit Enrollment Request
Clicking the Edit button will display the Edit Enrollment Request screen which shows all fields entered in the enrollment request. If any additional information is needed to complete the request, it will be displayed in a red box at the top of the screen. If custom questions are requested, enter the appropriate answers in the Additional Details section at the bottom of the screen. Click Resubmit Request once you have provided the additional information and/or answered the requested questions.

Enrollment Approval

Once an enrollment is approved, some payers will send the approval notifications to Waystar while others may send them directly to you. If the payer sends you the approval notification, please be sure to create a Support case to inform Waystar that your enrollment has been approved so they can activate your enrollment requests. For complete instructions on how to create a case with Waystar, check out the Guide for Requesting Help with Enrollment.

Enrollment Phase Definitions

Phases requiring provider action are denoted by an asterisk*.

Enrollment Phase Definition / Action To Be Taken
Provider Action Required * The request was not submitted or additional information is needed before the request can advance to the next phase.
Provider Complete and Return Form * Waystar has sent a manually-prepared form to the account’s Enrollment Contact to be completed and returned.
Provider Print and Return Form * The enrollment request has been created, but you must print a form and follow the cover sheet instructions.
Additional Information * If you are required to print and/or complete forms and return them to Waystar, please create a Support Case and attach the necessary forms to the case. The requests will automatically move to the appropriate phase upon receipt of the requested forms.
Awaiting Form from Provider You have indicated that you have printed the form and returned it to Waystar. After Waystar receives the forms, they will verify that they are accurate:
  • If no discrepancies are found, the forms will be forwarded to the payer.
  • If a discrepancy is found, you will be notified of the steps to correct it.
Pending Internal Review You have completed the online enrollment instructions and have acknowledged in the system that you've done so. The remit enrollment request is now placed in this phase for internal validation before completion. Note: Remits requests are completed daily. 
Form Being Prepared * Waystar must manually prepare a form. If the form cannot be completed by Waystar, you will be notified of the steps to correct it:
  • If a signature is required, the form will be emailed to the enrollment contact on the account. They will need to follow the instructions included in the email to complete the form.
  • If a signature is not required, Waystar will send the agreement directly to the payer.
Pending Electronic Processing Waystar will process the enrollment request and send any necessary information to the payer to initiate enrollment. This is for any enrollment item that does not require a form or signature.
Pending Electronic Delivery Waystar is awaiting an automated response as to whether the enrollment request was processed successfully. No signature or form is required.
Pending Payer Approval * Waystar has sent forms to the payer and is waiting for an approval or denial. Payers may take 30 to 45 days to approve enrollment agreements after they are received. Waystar will follow up with the payer—within the timeline set by the payer—to check the status of your enrollment. Waystar will update the enrollment screens when the enrollment agreements have been approved, then the transactions may be sent to the payer.
If you receive an approval notification directly from the payer, please create a case in Waystar’s Support and Training Center and attach the approval.
Note: Enrollments for the Remits application never enter the Pending Payer Approval phase.
Pending First Remit File The equivalent of the Pending Payer Approval phase for all Remits enrollment requests. In most cases, payers do not send remit enrollment approvals; therefore, when remit enrollment forms are sent to the payer for processing, the enrollment request becomes a record. This ensures that remits will post to the appropriate account.
Remits will automatically post to the appropriate account after the payer approves the enrollment.
Provider Download Instructions * The enrollment instructions are ready to download and review. Download the enrollment instructions to move your request to the next phase in the enrollment process.
Provider Complete Instructions * Select the appropriate request item and click the Complete Downloaded Instructions toolbar button to submit your request for internal review. Alternatively, you can hover over the requested item and click the Edit hover action button (see image above). Then click the Instructions Completed link in the Provider Complete Instructions section.
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