Accurately Submitting Medicare ERA Enrollment Form

Most providers face significant challenges when enrolling to receive ERAs (Electronic Remittance Advice) from any Medicare health plan. Some of the challenges include: a wide variety in data elements requested for enrollment; variety in the enrollment processes and approvals to receive the ERA; Absence of critical elements that would address essential questions regarding provider preferences on payment options. We omitted data fields like address, which are easy to fill. Below mentioned data fields will help in accurately submitting Medicare ERA enrollment form.

Data Fields for Submitting Medicare ERA Enrollment Form

Provider Information

  • Provider Name: Complete legal name of institution, corporate entity, practice or individual provider
  • Doing Business As Name (DBA): A legal term used in the United States meaning that the trade name, or fictitious business name, under which the business or operation is conducted and presented to the world is not the legal name of the legal person (or persons) who actually own it and are responsible for it.

Provider Identifiers

  • Provider Federal Tax Identification Number (TIN) or Employer Identification Number (EIN): A Federal Tax Identification Number, also known as an Employer Identification Number (EIN), is used to identify a business entity.
  • National Provider Identifier (NPI): The NPI is a unique identification number for covered healthcare providers. Covered healthcare providers and all health plans and healthcare clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. 
  • Assigning Authority (required if Identifier is collected): Organization that issues and assigns the additional identifier requested on the form, e.g., Medicare, Medicaid 
  • Trading Partner ID (optional): The provider’s submitter ID assigned by the health plan or the provider’s clearinghouse or vendor
  • Provider Type: A proprietary health plan-specific indication of the type of provider being enrolled for ERA with specific provider type description included by the health plan in its instruction and guidance for ERA enrollment (e.g., hospital, laboratory, physician, pharmacy, pharmacist, etc.)
  • Provider Taxonomy Code: A unique alphanumeric code, ten characters in length. The code set is structured into three distinct ‘Levels’ including Provider Type, Classification and Area of Specialization. 

Provider Contact Information

  • Provider Contact Name: Name of a contact in provider office for handling ERA issues
  • Email Address: An electronic mail address at which the health plan might contact the provider

Provider Agent Information

  • Provider Agent Name: Name of provider’s authorized agent
  • Provider Agent Contact Name: Name of a contact in agent office for handling ERA issues
  • Federal Agency Information: Information required by Veterans Administration

Retain Pharmacy Information

Pharmacy Name: Complete name of pharmacy
  • Chain Number (optional): Identification number assigned to the entity allowing linkage for a business relationship, i.e., chain, buying groups or third party contracting organizations. Also may be known as Affiliation ID or Relation ID
  • Parent Organization ID (optional): Headquarter address information for chains, buying groups or third-party contracting organizations where multiple relationship entities exist and need to be linked to a common organization such as common ownership for several chains
  • Payment Center ID(optional): The assigned payment center identifier associated with the provider/corporate entity
  • NCPDP Provider ID Number: The NCPDP assigned unique identification number
  • Medicaid Provider Number: A number issued to a provider by the U.S. Department of Health and Human Services through state health and human services agencies

Electronic Remittance Advice Information

  • Preference for Aggregation of Remittance Data (e.g., Account Number Linkage to Provider Identifier): Provider preference for grouping (bulking) claim payment remittance advice – must match preference for EFT payment
  • Method of Retrieval: The method in which the provider will receive the ERA from the health plan (e.g., download from health plan website, clearinghouse, etc.)
  • Electronic Remittance Advice Clearinghouse Information
  • Clearinghouse Name: Official name of the provider’s clearinghouse
  • Clearinghouse Contact Name: Name of a contact in clearinghouse office for handling ERA issues

Electronic Remittance Vendor Information

  • Vendor Name: Official name of the provider’s vendor
  • Vendor Contact Name: Name of a contact in vendor office for handling ERA issues

Submission Information

  • Authorized Signature: The signature of an individual authorized by the provider or its agent to initiate, modify or terminate an enrollment. May be used with electronic and paper-based manual enrollment
  • Written Signature of Person Submitting Enrollment (optional): A (usually cursive) rendering of a name unique to a particular person used as confirmation of authorization and identity
  • Printed Name of Person Submitting Enrollment: The printed name of the person signing the form; may be used with electronic and paper-based manual enrollment
  • Printed Title of Person Submitting Enrollment: The printed title of the person signing the form; may be used with electronic and paper-based manual enrollment
  • Submission Date: The date on which the enrollment is submitted
  • Requested ERA Effective Date: Date the provider wishes to begin ERA

Credentialing and enrollment for Medicare, Medicaid or even for private insurance carriers offer lot of challenges. There is so much information needs to be submitted, in right format, to complete the application. Medical Billers and Coders (MBC) is a leading medical billing company providing complete revenue cycle services. We can assist you in credentialing, enrollment, and EFT and ERA registration. Our expert billing team is well versed with all the forms and applications, resulting in quicker registration. To know more about our services and Medicare ERA enrollment form, contact us at 888-357-3226 

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