To submit Claims in TheraNest using Apex as your Clearinghouse, you will need to subscribe to TheraNest Claims and then enroll with your Payers through Apex. This is a great article to bookmark for reference as you work through the Enrollment Process.IMPORTANT: Apex has now partnered with Change Healthcare to process Enrollments.
- If you have completed Enrollments with Madaket before 5/1/21 you will not need to re-enroll your Payers with Change Healthcare. Any new Payer Enrollments will be completed with Change Healthcare.
- If you have in-progress Enrollments with Madaket you will complete those Enrollments with Madaket, but any new Enrollments going forward will be processed with Change Healthcare.
- Learn more about the switch to Change Healthcare and what it will mean for you.
This is the process listed above with all the handy links you could need to walk you through every step of your enrollment.
STEP 1: Subscribe to TheraNest Claims with Apex. This tells TheraNest that you want to use our services and enroll with Apex.
- Click Billing tab in primary navigation bar.
- Click Claims in side menu.
- Click Request Electronic Claim Service and Agree to Terms and Conditions.
STEP 2: Enroll with Apex in TheraNest.
- Enroll as a Individual (Type 1 NPI)
- Enroll as a Group (Type 2 NPI)
- Enroll as a Combination (Type 1 NPI and Type 2 NPI)
- I'm not sure how I should enroll.
STEP 3: Apex, Change Healthcare, and YOU! - Apex will send your enrollments to Change Healthcare, a 3rd party automation service that helps process your Enrollments more efficiently. Once received, Change Healthcare will reach out to you.
STEP 4: Process your Enrollments with Change Healthcare - A Change Healthcare Rep will reach out to you within 2 business days of your Enrollment and will then work with you to complete your Enrollments with each Payer. They will also help navigate any rejections.
STEP 5: Payer Approved - After the Enrollment has been completed processed and your Enrollment is verified as Approved, you can switch your Payers to Apex in TheraNest and begin billing!
TheraNest Claims FAQs
- Do I have to enroll with Apex Clearinghouse for TheraNest Claims?
Yes, if you want to subscribe to our TheraNest Claims service, Apex Clearinghouse is the clearinghouse you must use.
- What exactly is Enrollment (or Apex Enrollment)?
Enrollment is a process that lets your Payers know that you will be submitting electronic Claims (EDIs) and receive ERA's through our Clearinghouse partner, Apex EDI.
IMPORTANT: This is not the same as getting credentialed with Payer.
- I'm already enrolled with my Payer. Do I have to enroll again?
Yes, if you're enrolled with another Clearinghouse or with a Payer, you will still need to enroll with that Payer in Apex through TheraNest in order for Claims to come into TheraNest using Claims.
- How long does enrollment take?
It can up to 45 business days to be approved. This is will be different for each Payer and may depend on if additional forms are required to process your enrollment. Learn more about your Enrollment Status.
IMPORTANT: Because the enrollment time varies from Payer to Payer, we suggest that you do NOT hold on to Claims until you are approved.