Entity not approved as an electronic submitter.

While most payers, you can just begin submitting electronic claims (EDI claims) to them without any fuss, there are some payers that require what is called EDI enrollment.   EDI enrollment is basically a form that you submit to the payer letting them know that you will be submitting to them electronically and letting them know what clearinghouse you will be submitting through.

EDI enrollments are specific to a billing NPI (equivalent to Box 33A on the CMS-1500).   Therefore, when you perform EDI Enrollment with a payer, make sure you use the NPI and Tax ID that you will be sending as the billing NPI on your claims to that payer.

I already did EDI enrollment with this payer.

First, make sure the NPI that you have going out in Box 33A is the same NPI that you performed EDI enrollment with (remember, the EDI enrollments are specific to an NPI).  Second, make sure the Tax ID that you have going out in Box 25 of the CMS-1500 is the same Tax ID you put on the EDI enrollment forms.  Lastly, because this specific message is from the payer, you may need to call them to find out why they are rejecting.

IMPORTANT: When calling the payer, make sure to let them know that the claim was EDI rejected.  Usually, when you call, the first person you talk to is in the payers adjudication department.  These people can only see claims that made it past EDI (were not EDI rejected).  You may ask to talk to their EDI department or whoever handles EDI rejections.  They will have a record of the rejection.

How do I perform EDI Enrollment

It is not usually best to go to the payers website to get the EDI Enrollment forms.  The reason is that those forms will ask for technical information about the clearinghouse which you may not know.  Instead, email support@therabill.com and ask for the EDI enrollment forms (make sure you include the name of the payer in the e-mail).  Therabill support will get the forms from the clearinghouse and give them to you.  Typically, these forms either have the technical information filled in for you or have instructions listing the technical information that you will need.

Do not hesitate

Because EDI enrollment is a requirement of the payer and it is the payer that is processing the EDI enrollment forms, Therabill does not have any control over how long it takes.   Some payers may process same day while some may require up to a month.   For this reason, you will want to get the EDI enrollment forms to them as fast as possible to avoid cash flow issues.