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).

EDI:

Provider --> Claim ---> Insurance

ERA:

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 payer 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. 

NOTE:  When you are on the Payer Enrollment with Apex Clearinghouse screen, you can click on the "here" link to view the Knowledge Base articles that are related, as well as hover your mouse over the blue "i" icons for more info.

Once you have submitted your enrollment request, this will go to Apex EDI and Madaket.  Madaket will send you an invitation via email to set up your Madaket Provider Portal within 24 hours.

Setting up your Madaket portal account

  • When you are added as a user to the Madaket portal, you will receive a welcome email from support @madakethealth.com. This will include a link to activate your Provider Portal account. 

  • To activate your account, click on ‘Activate Account’. You will be prompted to reset your password. Once your password is reset, you can log into the system. 
  • You can access Provider Portal by navigating to the website below and logging in with the credentials you set up previously. URL: https://apex.madakethealth.com/auth/login

It is important to follow all these enrollment instructions carefully and complete all items in your Work Queue within your Madaket

Payer response times can vary.  

  • In your Madaket Provider Enrollment Portal, when you click on Enrollment Dashboard and then Out to Payer Enrollments, there is a column called Estimated Approval Date.  This date is based on how long the average enrollment with this payer takes.  Once this date passes, there are a few things that can happen:
    • If the payer responds to Madaket email prompts, Madaket will email the payer to ask for the approval status.
    • If the payer does not respond to Madaket, then an orange triangle will appear letting you know that you should follow up with the payer using the contact information available in the notification.  You can then update that enrollment when you are told it is approved and it will drop off the Out To Payer Enrollments List.

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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