Permissions You must have Organization Administration Permissions.
You must have Organization Administration Permissions in order to enroll as you will be the main point of contact for the entire enrollment process, including questions, clarifications, contact for any additional enrollment forms needed, and enrollment status notification with Apex Clearinghouse.
After you have subscribed to TheraNest Claims, you will enroll your Payers with Apex. Before you begin enrollment, you will want the following information handy:
Find Out if Your Payer Requires EDI/ERA Enrollment
Some Payers required EDI Enrollment before you can submit Claims to them. Check out this list of Apex EDI Payers to see if yours requires EDI/ERA Enrollment.
- If there is a Red dot in the Claims Column - an EDI Enrollment is required and you must wait for approval in order to submit electronic claims to this Payer.
- If there is a Green Dot in the Claims Column - there is NOT an EDI Enrollment and you can begin submitting claims to this payer via Apex immediately!
You must be approved by your Payer before you can submit Claims to them using Apex. Don't worry - you will still be able to submit Claims to this Payer through your current Clearinghouse while you wait for approval.
IMPORTANT: The Apex Payer ID could be different that the Payer ID for your current Clearinghouse.
EDI and ERA are both types of communication.
- EDI is permission for the Customer/Provider to send the claims electronically to the insurance.
- ERA is permission for the insurance to send the processing information back to the Customer/Provider.
Know How You are Credentialed with Each of Your Payers
If you are not 100% sure how you are credentialed with your Payer, it is very important for you to find out. This will save you a lot of work and time in the future. If you enroll incorrectly you will be rejected and have to complete the enrollment process again for each Payer that rejects you. You may be credentialed different with each Payer. Some Payers you may need to enroll as a Group and other Payers you may need to enroll each Provider individually. We suggest you find this information out before enrollment opens.
If You Submit to Medicare, Know or Find Your PTAN Number
You can find your PTAN number on the Welcome Letter you received from Medicare when you were credentialed. If you can’t find that letter, simply call your Provider Representative at Medicare and they can give you that.
IMPORTANT: Do NOT Hold on to Claims Till You're Approved By Your Payer with Apex EDI
Some Payers do not require enrollment and therefore, you can start submitting to them right away. However, there are Payers that DO require enrollment and we have to wait to be approved by them before submitting. When enrolling with a Payer with Apex Clearinghouse it can take up to 45 business days to be approved by some Payers. If you are rejected you will need to go through the enrollment process again with your corrections.
Because of this and with regard to timely filing we ask that you do NOT hold on to Claims until you've received your approval notification from TheraNest. Please do not disrupt your payment and continue to bill as you currently are until you've been approved. Again, do NOT hold your Claims.