Several payers, usually Medicare and Medicaid, require that you let them know what clearinghouse you will be sending them your claims through. Therabill refers to this as clearinghouse authorization, but it can also be referred to as EDI enrollment.
IMPORTANT: The EDI Pre-enrollment is attached to your billing NPI. The billing NPI is the NPI that goes in to Box 33A of your CMS-1500 claim form. You only need to do EDI Pre-enrollment once for a specific payer for your billing NPI. If you are going to submit using multiple billing NPI, then you will need to do separate EDI pre-enrollments for each billing NPI.
If you receive this error, it can mean a few things.
- You have sent in the EDI enrollment (clearinghouse authorization) forms, but the payer has not yet processed the forms.
- You have not yet sent in the EDI enrollment forms.
- You did the EDI pre-enrollment, but you are using a different billing NPI on this claim (the billing NPI you are submitting is not the same billing NPI you entered on the EDI Pre-enrollment forms).
If you are in category 1, then you will need to wait until the payer has informed you that they have processed your forms and that you have been linked to the clearinghouse in their system. Once they have informed you that you have been linked, you can then resubmit the claim directly from the error page by clicking the Resubmit Electronically button at the top of the error page.
If you are in category 2 or category 3, then you will want to e-mail support@therabill.com and ask for clearinghouse authorization instructions for this payer. Therabill will then send you the required forms, along with the technical information about the clearinghouse (which is often required on the clearinghouse authorization forms).
The average processing time for payers to process your clearinghouse authorization forms is 5-10 days. However, there are some payers that can take up to 4-6 weeks. If this is the case, you may want to consider submitting by paper while they are processing your clearinghouse authorization forms. Therabill can create paper claims for you to print out and mail in when you are creating the claim, by choosing the "Print & Mail" option.
For the claims that came back in error, you can either resubmit by paper or wait until they have processed your forms and then resubmit electronically. Both options are available to you directly from the error page using the resubmit options at the top of the error page.
Error Variations
- Payer Requires Pre-Enrollment for Electronic Claims Submission. Provider is not yet approved to submit claims electronically to this payer.
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