How to switch your clearinghouse from Office Ally to Apex
How to switch your clearinghouse from Office Ally to Apex clearinghouse
EDI and ERA Enrollment
What is EDI and ERA (Electronic Remittance Advice) Enrollment? And why is it important?
EDI is permission for the provider to send the claims electronically to the insurance payer, and ERA is permission for the insurance payer to send details about how claims were paid or denied, to the provider. An ERA is an electronic version of the “explanation of benefits” (EOB).
Provider --> Claim ---> Insurance
Insurance --> EOB --> Provider
Some, but not all, payers require EDI Enrollment before you can submit claims to them electronically. Some important notes:
- Only enroll for EDI enrollment for those payers that you are contracted with.
- Not all payers require EDI enrollment and they can be switched to Apex at any time.
- If you do not currently receive ERAs, you are not required by My Clients Plus to enroll for them, however, some payers may require ERAs as part of their EDI enrollment.
How do I enroll for EDI and/or ERA:
To begin the enrollment process for EDI and/or ERA, click on the Important tile on the Home Screen of MCP 2.0, then click on Go to Pre-Enrollment at the bottom.
When you have clicked the Go to Pre-Enrollment button at the bottom of the screen, you will be taken to an EDI/ERA enrollment survey. On this survey, you will select the options that apply to your practice and enter your information as needed, then click Next to progress through the survey.
At the end, you will be asked about receiving ERA's. If you are interested in receiving ERA's in Apex, simply type in the payer name (and Payer ID if available) to notify Apex you would like to sign up for ERA's for the requested companies.
Once you've completed and submitted the EDI/ERA Enrollment survey, you will receive an email(s) from Madaket with the required forms or instructions to complete for the different payers enrollment processes within a few days. You will need to follow the instructions in those emails to complete the enrollment for any selected insurance companies.
Change your Subscription to Apex:
NOTE: If you bill to payers that require EDI enrollment, please do NOT transition to Apex until you have verified that your EDI enrollment(s) by payer have been completed for Apex Clearinghouse AND APPROVED at the payer. Once you have verified that you are either enrolled with payers that require EDI enrollment or your payer(s) do not require EDI enrollment:
- Go to My Payment Info > Payments & Subscriptions > Manage Subscriptions
- Click on the appropriate Apex subscription level.
- Once you have selected an Apex subscription level and clicked Save, you will no longer be able to select an Office Ally subscription.
- Your default payer list will now be Apex. Only those Office Ally payers that you have set up will be in the payer list and they will be labelled as Office Ally.
Change your Payers from Office Ally Payers to Apex Payers
To change your individual payers from Office Ally payers to Apex payers, click on the Electronic Claims tile on the Home page of your MCP 2.0 account.
Scroll to the bottom of the page below the Electronic Claim Status report where you will see the Office Ally payers used in this account on the left hand side. Simply click on Please Choose an Option and select the appropriate payer for the Apex Clearinghouse that corresponds with each Office Ally Payer and click Update Payers.
You will be required to enter your password for verification that you understand that this process will convert the Office Ally payer to the selected Apex Clearinghouse payer and that the automated process cannot be reversed. You can manually switch a payer in a client record through Client Setup > Primary or Secondary Payer if you need to make any changes.
Once you have completed the process, the payer will be removed from the screen. You will know you have completed the process when there are no longer any payers in the list to convert to a payer on the Apex clearinghouse payer list.