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.
This is the process for enrollment with Apex:
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 - You will receive a welcome packet via email. Return this information as soon as possible. When your information is received, you will be assigned an Enrollment Rep who will communicate all further enrollment steps directly with you. If you have not been contacted within seven business days, reach out to our support team.
STEP 5: After the EDI enrollment has been approved - If an EDI Enrollment is not required for this payer and you are only doing an ERA Enrollment, you can begin submitting claims to this payer immediately. You will receive paper remits/EOBs until the ERA enrollment is approved.
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.