What does it mean when it says I need to be enrolled for Eligibility? Do I need to enroll?
If you would like to use the Eligibility feature and you went through claims and ERA enrollment prior to Sept 19, then you will need to enroll through the clearinghouse for Eligibility.
When you sign up for Eligibility and you had previously had Apex EDI payer enrollments completed prior to Sept 19, 2022, Theranest will automatically send an enrollment request to Apex EDI clearinghouse for you.
If I am a newer practice and I just started with Theranest billing after Sept 19th, do I need to enroll for Eligibility?
If you started claims service with Theranest and have enrolled since Sept 19th for any enrollments, Apex EDI clearinghouse automatically enrolled those payers for Eligibility if offered by the payer.
How long does enrollment take for those payers that require it?
Once you have met or corresponded with a the Apex Enrollment team, it typically takes about 7 – 10 business days once they submitted the enrollments to the payer for eligibility. The Apex Enrollment team should let you know when the enrollments are completed.
How do I know what Payers need enrollment for Eligibility?
Most payers do not require enrollment for Eligibility and you will be able to submit requests right away. Those Payers that do require enrollment are typically Medicare, some Medicaid, Blue Cross Blue Shield, Kaiser, Aetna, Health Partners of MN, and a few others. For payers requiring enrollment you can begin running eligibility checks once your enrollment has be approved.
For any other payers that offer Eligibility and do not require enrollment, you can begin submitting Eligibility requests immediately once you have turned on the Eligibility option.
How do I know what payers offer Eligibility?
Click this link for the Apex EDI clearinghouse payer list which shows payers that offer Eligibility:
Apex EDI Payer List
See the Apex Payer ID List article for information on working with the payer list.
Does it cost me anything to enroll for Eligibility?
There is no charge to enroll for Eligibility, but there is a charge to process an Eligibility check.
How much do Eligibility checks cost?
Eligibility checks are $ .25 per check.
What information is submitted from my Theranest account to successfully get an Eligibility result?
- Payer Id and Insurer Name
- Client details: First Name, Last Name, SSN, DOB, Sex
- Group Number and Insured Id Number
- Organization NPI