How to switch your clearinghouse from Office Ally to Apex

How to switch your clearinghouse from Office Ally to Apex clearinghouse

For those providers and practices who are currently set up with Office ally as their default clearinghouse and would like to switch their clearinghouse from Office Ally to Apex, there are a few steps to take:

Read below or watch this step by step video!


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).

EDI:

Provider --> Claim ---> Insurance

ERA:

Insurance --> EOB --> Provider

Some, but not all, payers require EDI Enrollment before you can submit claims to them electronically.  If you don't know if the payer requires EDI Enrollment, go back to Code Setup > Insurance Company and start the enrollment process to see if your payers require EDI Enrollment.  

  • 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 payer may require ERAs as part of their EDI enrollment.

How do I enroll for EDI and/or ERA:

To enroll for EDI and/or ERA, click on the Important tile on the Home Screen of MCP 2.0.

NOTE:  The last box of this enrollment process is for ERAs.  Please review the list carefully.  If you currently receive ERAs through Office Ally, please make sure you have the appropriate payers listed in the ERA Enrollment page.  If you do not currently receive ERAs through Office Ally, you may choose whether to begin receiving ERAs or to delete them from the enrollment form prior to form submission to Apex.

What happens next?

Once you have submitted the enrollment request to Apex EDI, Apex will pull your enrollment requests together and send them to Madaket (a third party who is contracted with Apex to manage the enrollment process paperwork).  

It may take 1-10 days for Apex to process the enrollment request and send the enrollment to Madaket.  It may take Madaket 1-10 days to process the request in one of the methods below.

Depending on the requirements of the payer, Madaket may:

  • Send enrollments directly to the payer
  • Enrollments that require action from the provider such as Signatures, additional information or voided checks will be emailed to the contact person on the enrollment request
  • Send instructions on how to log into the online payer provider portal to update information.

 It is important to follow all these enrollment instructions carefully.

You can expect emails from Madaket within about 10 days if there is any follow-up required by the provider.

Payer response times can vary.  

  • Online EDI enrollment - this process is typically ready to go within a couple of days
  • EDI enrollment where forms are sent to the payers - these can vary from 2 - 6 weeks depending on the payer
  • ERA enrollments - these can be up to 60 days depending on the payer

Once the EDI (claims submissions) enrollment is approved, you will receive an email from My Clients Plus letting you know it is approved.  There are some cases where the payer may not respond to Madaket inquiries on enrollment status and the provider will need to follow up directly with the payer to see if the payer has processed their recent enrollment request.

With ERA (electronic remittance advice) enrollments, payers do not always let Madaket know when they are approved.  You should begin seeing ERAs in your My Clients Plus account when they begin flowing through Apex EDI clearinghouse .  

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.

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