Enrollments Overview

Enrollments are electronic connections with a payer that enable your organization to send and receive information electronically. This information includes:

• Eligibility Checks
• Claim Submissions
• Remits (ERAs)

How Do Enrollments Work?

When a new payer is added to your RCM configuration and requires enrollment, our team will be notified to begin the enrollment process. Payers that require any kind of enrollment can be identified in their profile. Once notified, any required enrollments from the payer will be added to your organization's Smartsheet.

What Is a Smartsheet?

Each payer has different enrollment requirements and connection processes. Because of these variances, your enrollment specialist will create a shared Smartsheet so that your organization can create and track enrollment requests and view any additional steps required for enrollment. 

Why Are Enrollments Important?

Because incomplete enrollments can affect your workflow, we highly recommend checking your Smartsheet every two weeks to ensure all requests are handled promptly. Not completing enrollments can affect your ability to submit claims electronically, check eligibility, or post payments automatically.

Enrollment Type	Definition	Limitations
Claim Submission (Professional and Institutional)	The payer requires enrollment to be complete before claims can be submitted electronically.	Claims must be sent via paper or uploaded directly to the payer portal.
Remits (ERAs)	The payer requires enrollment to be completed before remits can be ported into the RCM.	Payments must be manually posted to claims.
Eligibility	The payer requires enrollment to be completed before eligibility checks can be performed.	Verification of benefits must be made by phone.

Smartsheet Overview

When you are in implementation, your enrollment specialist will create your Smartsheet so that you can begin working on enrollments together. Each line contains the information pertinent to the enrollment, such as the payer name, ID, enrollment type, and status. Let's review each of these components together!

• The Organization column displays the organization name as it appears in the RCM. 3rd-party billers will often see multiple organizations listed under their Managing Organization umbrella.
• The Practice column will mirror the practice name in the RCM. This information is important as it helps identify the NPI and Tax ID associated with an enrollment. Though many enrollments use the Tax ID to make the connection, additional enrollments may be required if there are multiple facilities with different NPI/Tax ID combinations.
  
• The Payer and Payer ID columns are used to identify the payer's name and the electronic ID listed in the payer request.
  
• The Enrollment Type column shows the line of business that requires enrollment with the payer. Any payers that offer remits will always require enrollment before they can be routed to the RCM. Only some payers require a Professional or Institutional enrollment, but when they do, it is imperative that these enrollments are completed to prevent delays in claim submission.
  
• The status of each enrollment indicates its current stage. The statuses are assigned colors to help users quickly identify the next steps required to complete the enrollment. Click here to review the definition of each status.
  
• Every enrollment added to your sheet will include a comment from your enrollment specialist about additional requirements, or the enrollment's current status. Enrollments that require signatures or additional instructions have a paper clip icon next to the comment. Clicking on it displays the instructions or forms that must be completed before enrollment is finalized. You must monitor these comments to ensure there is no delay in establishing your connections.
  

Status Definitions

Click each box below to learn more about each status and its meaning in the context of the enrollment process.

• This status indicates that all necessary steps have been completed, and we are currently waiting for the clearinghouse to finish the connection.
• This status indicates that the connection has been established, and we are awaiting the first remit to confirm that enrollment is complete.
  
• For claim-submission enrollments, a complete status indicates that the connection is established and claims can be submitted electronically. For remits, a complete status indicates the enrollment is complete, and the first remit has been received.
  
• This status is used only for new clients in the implementation process. Because an enrollment for remits can only connect to one clearinghouse, we'll wait to start the enrollment process until you are ready to fully transition to our system to minimize any disruption in your revenue cycle.
  
• We use this status to indicate that we need additional information, such as a legacy ID, UPIN, provider ID, or Payee ID, to generate the forms required to enroll you.
• This status means we need you to take a few steps to help us complete the enrollment. This status will always have instructions attached to guide you through the process. Once you've completed the instructions, be sure to leave a comment to notify us so we can complete your enrollment.
• When this status is displayed, the attached form will require a signature from someone in your organization; this person's role may vary by payer. Please sign the form, reattach it to the line, and leave a comment to let our enrollment specialist know all required signatures have been gathered.
  
• This status indicates that enrollment cannot be completed until your organization is fully registered and credentialed with the payer.
  
• This status indicates that we are awaiting the payer's confirmation that your organization is fully registered and ready to begin the enrollment process.
  
• We canceled this enrollment because it's not available per the payer, your team has requested we not initiate it, or we haven't received a response from you in over 180 days. Please see the comments for details and let us know if you'd like us to reinitiate it.
  
• This status means a connection is usually available, but we are unable to complete it due to a moratorium imposed by the payer or the clearinghouse.
  
• We only start enrollments for payers who are currently being billed, so we reserve this status for enrollment requests created when adding a new payer on behalf of a prospective patient. If this changes at any point, leave a comment to let our enrollment specialist know you are ready to proceed.