All payers require providers to complete an enrollment process before they can start receiving claim remittances (ERAs). Some payers also require enrollment before allowing providers to submit transactions like claims and eligibility checks.

Transaction enrollment involves submitting information about the provider that will send or receive transactions, including the provider’s name, tax ID, NPI, billing address, and contact information.

You can find out if a payer requires enrollment for a particular transaction type in the Stedi Payer Network.

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Requirements

Transaction enrollment often requires completed credentialing and payer enrollment. Visit Enrollment types to learn more about these processes.

If a payer rejects your transaction enrollment request with a message indicating the provider is “not on file” or “not recognized,” it likely means the provider hasn’t completed credentialing and payer enrollment with that payer.

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Enrollment process

You submit a transaction enrollment request to the Stedi customer success team, and we’ll handle the entire enrollment process for you, including submitting the required information to the payer and monitoring the status of the enrollment.

All enrollment submission methods go through the same high-level stages:

1

Add a new provider record.

The provider record includes the information required to enroll the provider with payers, including the provider’s name, tax ID, NPI, and contact information.

When submitting enrollment requests through the UI or API, you must either first create a new provider record or reference an existing one. When you submit requests through bulk CSV import, Stedi creates provider records automatically.

2

Submit a transaction enrollment request.

You submit enrollment requests to enroll the provider with required payers. An enrollment request includes the provider record, the transaction type you want to enroll, the payer you want to enroll with, and a designated contact that the payer can communicate with about the enrollment. You must create one enrollment request for each transaction type. For example, you would create three separate requests to enroll a provider for 837P (professional) claims, 270 real-time eligibility checks, and 835 ERAs (claim payments).

With the Enrollments API, you can create enrollment requests in DRAFT status first and change the status to SUBMITTED later when you’re ready to submit them to Stedi. When creating enrollments through the UI or through bulk CSV import, requests are automatically submitted upon creation. Stedi only gets alerted about new enrollment requests once they’re in SUBMITTED status.

After you submit the enrollment request, you can no longer update it without contacting support.

3

Stedi submits the enrollment to the payer.

Stedi begins the enrollment process with the payer and sets the enrollment status to PROVISIONING.

Our network and enrollment operations team knows the nuances of each payer’s enrollment requirements and maintains a public repository of payers that require additional steps through our Transaction Enrollments Hub. If payers have additional requirements as part of their standard enrollment process, Stedi contacts you with clear, actionable steps to move the process forward. In addition to updating your enrollment request with action items required for your team, we’ll also reach out to you in your dedicated Slack channel with resources and to answer any follow-up questions.

You can cancel an enrollment at any time by contacting Stedi support in Slack. Once an enrollment is canceled, Stedi sets its status to CANCELED and stops the enrollment process with the payer.

In rare cases, the enrollment status might be set to REJECTED if the payer denies the enrollment request. Rejection can happen for many reasons, but the most common are that the provider isn’t credentialed with the payer and that there was incorrect data in the enrollment submission. If this happens, Stedi will contact you in Slack to help resolve the issue.

4

Enrollment is complete.

Once the enrollment is approved, the enrollment status is set to LIVE, and the provider can start exchanging the enrolled transactions with the payer.

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Create enrollment requests

You can submit enrollment requests in three different ways, depending on your preference. All requests go through the same high-level enrollment process once submitted.

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Individual UI submission

Creating individual enrollment requests through the Stedi portal involves two steps:

  1. Create a provider record: Visit the Providers page and click New provider.
  2. Create an enrollment request: Visit the Enrollments page and click New enrollment.

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Bulk CSV import

To create enrollment requests, go to the Bulk imports page and click New bulk import.

The upload page contains detailed instructions for formatting the CSV file. Once you upload a file, Stedi checks it for errors and notifies you of any issues preventing import. You can fix the errors in the CSV file and re-upload it as many times as needed. Once the file is error-free, you can click Execute import.

Stedi automatically does the following when importing enrollment requests from a CSV file:

  • Creates provider records as needed. Stedi creates a new provider record for each unique combination of NPI and tax ID in the CSV file. For example, these two providers would be created as separate records even though they have the same name and NPI:
    • John Doe, NPI: 1999999984, Tax ID: 987654321
    • John Doe, NPI: 1999999984, Tax ID: 123456789

    When a row in your CSV file contains an NPI and tax ID that match an existing provider record, Stedi overwrites the existing provider record with the information in the CSV file. Any changes (such as updated address or contact information) aren’t automatically applied to existing enrollment requests for that provider, only to requests created after Stedi updated the record.

  • Creates enrollment requests. You can track each request through the Enrollments page once the import is complete.
  • Removes duplicate rows to prevent duplicate requests.

After importing, you can download a report that shows the status of each row in the CSV file. For example, duplicate rows are marked as Duplicate: Enrollment already exists in the result column.

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API

Creating enrollment requests programmatically through Stedi’s APIs involves two steps:

  1. Create a provider record: Call the Create Provider endpoint.
  2. Create an enrollment request: Call the Create Enrollment endpoint. You can create enrollment requests in DRAFT status first and change the status to SUBMITTED later when you’re ready to submit them to Stedi.

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Review enrollment status

You can review the details and status of every enrollment request on the Enrollments page in Stedi. Alternatively, you can use the List Enrollments endpoint.

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Enrollments hub

Our network and enrollment operations team knows the nuances of each payer’s enrollment requirements and maintains a public repository of payers that require additional steps through our Transaction Enrollments Hub.

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FAQ

I’m already enrolled through another clearinghouse. Do I need to enroll through Stedi as well?

Yes. Enrollment is specific to each clearinghouse. So if a payer requires enrollment, you will need to go through the enrollment process with Stedi to begin exchanging transactions through the Stedi clearinghouse.

Once I enroll through Stedi, what will happen to the ERAs I currently receive through a different clearinghouse?

ERAs can only be sent to a single clearinghouse. Once you enroll for ERAs through Stedi, all ERAs from that payer to the provider you enrolled will come through Stedi. The provider will no longer receive ERAs from that payer through your previous clearinghouse.

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