Transaction Enrollment

Transaction enrollment is the process of registering a provider to exchange specific healthcare transactions with a payer. It involves submitting information about the provider, including their name, tax ID, NPI, billing address, and contact information.

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Do I need to enroll my provider?

For 835 Electronic Remittance Advice (ERAs), always yes. For other transactions, it depends on the payer.

Check the Payer Network or use the Payers API to determine whether your payers require enrollment for the transaction types you want to send and receive. Each transaction type is marked as either:

• Supported, enrollment not required
• Supported, enrollment required
• Not supported

For example, the following payer record shows that Blue Cross Blue Shield of North Carolina requires enrollments for 835 ERAs, as indicated in the transactionSupport.claimPayment property.

{
  "stediId": "UPICO",
  "displayName": "Blue Cross Blue Shield of North Carolina",
  "primaryPayerId": "BCSNC",
  "transactionSupport": {
    "eligibilityCheck": "SUPPORTED",
    "claimStatus": "SUPPORTED",
    "claimSubmission": "SUPPORTED",
    "claimPayment": "ENROLLMENT_REQUIRED",
    "dentalClaimSubmission": "SUPPORTED",
    "professionalClaimSubmission": "SUPPORTED",
    "institutionalClaimSubmission": "SUPPORTED",
    "coordinationOfBenefits": "SUPPORTED",
    "unsolicitedClaimAttachment": "NOT_SUPPORTED"
  }
  // truncated for brevity
}

If enrollment for a supported transaction type is:

• Not required: The provider can start exchanging transactions through Stedi right away. They’ll include their information (like their NPI) in transactions as needed.
• Required: The provider must complete transaction enrollment before they can start exchanging those transactions through Stedi. Note that ERA enrollment is exclusive to one clearinghouse. Switching a provider to Stedi stops ERA delivery through the previous clearinghouse.

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Enrollment process

Stedi handles the entire enrollment process for you, including submitting the required information to the payer and monitoring the status of the enrollment.

Here’s how it works:

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Enrollment statuses

An enrollment request can have one of the following statuses:

• DRAFT: You are still editing the record and it has not been submitted to Stedi.
• SUBMITTED: You have successfully submitted the request and it is in Stedi’s queue for review. Once you submit an enrollment request, you can no longer update it without contacting support. If an enrollment request is in this status for more than 2 days, we are likely waiting for additional information or action from the provider.
• PROVISIONING: Stedi has begun the process of completing the enrollment with the payer.
• LIVE: The enrollment process is complete, and the specified provider can begin exchanging the listed transaction types with the payer.
• REJECTED: The payer rejected the enrollment. Common reasons for rejection include incorrect details in the request and that the provider is not credentialed with the payer. Customer support will contact you with reasons for rejection and next steps.
• CANCELED: The enrollment has been terminated per customer or provider request.

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Delegated signature authority (recommended)

You can reduce manual work by 90% and complete enrollments significantly faster by authorizing Stedi to sign PDF enrollment forms on your behalf.

Here’s how delegated signature authority works:

1. Complete a one-time delegated signature authority agreement that gives Stedi permission to sign enrollment forms for you. If you manage enrollments for providers, you’ll also need to collect delegated signature authority from them during onboarding. We’ll provide a template form you can use.
2. Submit enrollment requests.
3. When a payer requires a signature, Stedi checks whether delegated signing is allowed.
   • If allowed, Stedi signs and submits the form automatically.
   • If not allowed, the provider must sign the form directly. Stedi notifies you on the enrollment request and provides instructions to complete the process.

Delegated signature authority is available on all paid Stedi plans. To enable it, contact Stedi support in your dedicated Slack or Teams channel.

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One-click enrollment

We offer one-click enrollment for eligible payers. Once you submit the enrollment request, Stedi handles the entire process without any additional action from you. These payers don’t require any signatures or documentation other than what is included in the enrollment request.

You can determine whether a payer is eligible for one-click enrollment by:

• Checking the Payer Network. Click a payer’s name to view its details. Stedi lists the Type as One-click for transaction types that support one-click enrollment.
• Calling the Payers API. The enrollment.transactionEnrollmentProcesses.{transactionType}.type property is set to ONE_CLICK for transaction types that support one-click enrollment.

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Rejected enrollments

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:

• The provider isn’t credentialed with the payer. 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. Visit Credentialing and enrollment to learn more.
• There was incorrect data in the enrollment submission.

If an enrollment is rejected, Stedi puts a note on the enrollment request explaining the reason and how to resolve it. You can review the note through the UI or API and contact Stedi support in Slack with any additional questions.

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Create enrollment requests

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 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. Requests are automatically submitted to Stedi upon creation.

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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 the file, Stedi checks for errors and flags any rows that require adjustments. You can either fix the errors and re-upload the CSV file or click Continue anyway to proceed with importing valid rows.

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 and submits enrollment requests. You can check the status of each request through the Enrollments page once the import is complete.
• Removes duplicate rows to prevent duplicate requests.
• Checks for errors. Stedi imports valid rows and skips any that contain errors. For example, if a row contains an invalid NPI, Stedi skips that row and imports the rest of the file.

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Import status report

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.

Rows with errors display a clear inline error message to help you quickly make the necessary adjustments. You can fix rows with errors and re-upload the CSV file as many times as needed until all imports are successful.

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API

Creating enrollment requests programmatically through Stedi 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 details

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

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Cancel enrollments

You can cancel an enrollment at any time by contacting Stedi support in Slack. This includes enrollments that are already in PROVISIONING or LIVE status.

Once an enrollment is canceled, Stedi sets its status to CANCELED and stops the enrollment process with the payer.

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Notification emails

Stedi sends a notification email once per hour with a summary of enrollment request status changes. The email includes a link to each enrollment request where you can review notes, instructions, and other details.

Email notifications are sent to the address designated as the Person for Stedi to contact about the enrollment. This is typically the email associated with the Stedi account that created the enrollment request, and it may differ from the provider’s designated contact.

If you aren’t receiving notification emails as expected, contact Stedi support in Slack.

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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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Practices and facilities with multiple providers or locations

Some healthcare organizations operate multiple facilities or practices under a shared structure. This is common in hospital systems, clinic networks, or large medical groups where multiple service locations operate under the same billing entity.

Here are some best practices for enrolling practices and facilities with multiple providers or locations:

• Create a single enrollment request when the same group NPI and tax ID are used as the billing provider in claims and ERAs. You don’t need to submit additional enrollment requests for individual rendering providers. When submitting claims, use the taxonomy code that matches the billing provider’s credentials.
• Select a single administrative entity as the contact - don’t include individual provider emails. This should be a credentialing or general inbox.

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FAQ

Do I need to enroll through Stedi if I’m already enrolled through another clearinghouse?

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.

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.

Does enrolling with Stedi cancel my enrollment with another clearinghouse?

For ERAs, yes. Once you enroll for ERAs through Stedi, the payer will stop sending ERAs to your previous clearinghouse.

For claims and other types of transactions, it depends on the payer. Some payers accept claims through multiple clearinghouses or direct connections. Customer support can help answer this question for your specific payers.

Can I send claims through Stedi without switching my ERA enrollments?

Yes, you can start sending claims through Stedi without enrolling for ERAs. The ERAs will still go to your current clearinghouse. In Stedi, you’ll see the claim and the 277CA claim acknowledgment from the payer, but you won’t see ERAs until you switch those enrollments to Stedi.