ClaimsConnect Enrollment & Set Up Tips
March 28, 2019
- Claims Connect enrollment forms should be completed at the group billing NPI level. (box 33 on a HCFA 1500 form).
- Every provider that submits a claim needs a P#, regardless of group affiliation. P# is provided when our EDI team processes your enrollment forms.
- Each provider with active P# and will be invoiced monthly for service per enrollment agreement.
- Enrolled providers must be listed in your Helper program in the Therapist/Provider library to submit claims electronically through ClaimsConnect.
- Enrolling in ClaimsConnect does not affect your payments from payers (insurance companies); whether you receive checks or EFT, that will continue per your set up with each payer.
- ERAs: What is an ERA? Electronic Remittance Advice - basically stated, this is your paper EOB submitted electronically and downloaded straight into Helper.
- Each provider signing up for ERAs must be enrolled in ClaimsConnect.
- You may choose to enroll in ERAs for any payer you are currently billing. Set up will be completed using group NPI and tax ID unless otherwise specified.
- Individual and Group NPIs:
- Providers who are individuals/sole proprietors use Type 1 (individual) NPI
- Organizations/group practices have Type 2 (Group) NPI, sometimes called Business or Non-Person
- Rendering provider vs. Billing Provider
- Rendering Provider is the provider rendering care, Individual NPI
- Billing Provider (Pay-to Provider) is the entity or provider that the payer (insurance company) issues payment to – can be either Individual NPI or Group NPI
- Billing NPI – which to use?
- If sole provider with Type 1 (individual) NPI only, the rendering and billing NPI will match the Individual NPI
- If group practice; the billing NPI will be Type 2 Group NPI