FAQ - Apex EDI Enrollment

FAQ - Apex EDI Enrollment

 Filling out forms: 

Q: I received many forms for ERAs – some for insurance companies I don’t even send claims to. Do I have to complete all of it? 
A: You only need to complete the paperwork for the ERAs that you would like to receive. If you don’t send to an insurance company often, or prefer to receive paper EOBs, no need to complete that paperwork. Please let Apex EDI Enrollment or My Clients Plus know to cancel an enrollment if you no longer need it.
Q: The form is asking for my checking information – I already have EFTs set up, do I need to fill that out? 
A: We advise that yes, you should complete that section. Even though you are already setup with EFTs – the insurance company will reject your ERA application without that info. 
Q: The paperwork has a different name than Apex EDI on it – did I get sent the right stuff? 
A: Yes, many insurance companies contract with third parties to manage their ERA & EFT program. You will often see Availity, Office Ally, PaySpan, Change Healthcare, etc listed on that form. 
Q: My information on the form is incorrect – what do I need to do? 
A: Please update the information through the enrollment tool located in your account in Code Setup > Insurance Companies > Apex Payer Enrollment.  There is an option to add a correction for your enrollment.

ERA Processing: 

Q: This is taking so long – is something going wrong? 
A: ERA processing generally takes longer than claim enrollment. While typically ERA enrollment will complete (approve or reject) within 30-45 days, many insurance companies take a least 60 days to process. Be aware that industry changes can also delay this time frame. 
Q: How will I get ERAs while the paperwork is processing? 
A: If you were setup with ERAs through your old clearinghouse, you should receive them through there until you get an approval. Be aware – many clearinghouses will stop sending ERAs to your account if you have stopped sending claims. You should contact your old clearinghouse to let them know to continue to direct them to you. 
If you didn’t have ERAs with your old clearinghouse, or this is your first time submitting electronic claims – you will receive your EOBs in the same fashion you did before. 
Q: I started getting paper EOBs since submitting paperwork – did I accidentally sign up for a paper connection? 
A: No, some insurance companies will start sending paper EOBs while the paperwork is processing. They recognize that many clearinghouses shut off ERAs if you aren’t using them – so the insurance drops them to paper so you don’t miss anything. 

ERA Status: 

Q: I am getting ERAs, but my enrollment status still indicates that the paperwork is pending? What is going on? 
A: Most insurance companies will only work with a provider’s office on the status of ERA applications. This means that Apex is never notified on the acceptance or the rejection of certain forms. If you get an ERA, or get a email from the payer regarding the status of your application – please let Apex EDI clearinghouse or My Clients Plus know so that Apex EDI can update your enrollment status in their system. 
Q: If some insurance companies don’t consistently send back ERA statuses, how can I know what the status of my paperwork is? 
A: You will want to call the payer and ask them, “What is the status of my recent ERA application”. The key is that the application has been approved or that a change has been made. 
Q: I called the insurance company and asked them, “What is the status of my recent ERA application” and they said they are sending the ERAs to a company that isn’t Apex…do I need to be alarmed? 
A: No, many insurance companies hire outside firms to manage the paperwork and processing of payments and ERAs. The key is that the application has been approved. 
Q: Why won’t Apex EDI call on this application? Isn’t that their job? 
A: The Apex EDI goal is to make this as easy as possible for the provider – where they can get the status of an ERA application they do. Unfortunately, many insurance companies won’t work with a clearinghouse on the status of this paperwork because they view it as financial/secure information for your office. 

Missing ERAs: 

Q: I started getting ERAs via Apex from an insurance company, but they seem to have stopped? What is going on? 
A: The good news is that if you have received ERAs through Apex for an insurance company before – it means your enrollment has been approved. Often times, payments will post in a bank account 2-3 days before we receive the ERA from the insurance company. If you are still missing that ERA after a couple of days, contact My Clients Plus with the following information:
  • 1) Name of the insurance 
  • 2) Check # 
  • 3) Check Amount 
  • 4) Organization Name 
  • 5) Tax ID 
  • 6) NPI 
  • 7) Payment date 

We will work with Apex EDI to research the check(s).

Q: I have never gotten ERAs for a certain insurance company – I have called them and they told me they are sending them out and won’t give me more information. What do I do now? 
A: The first thing you will want to do is see if your old clearinghouse is still getting those ERAs. If they are, it means your paperwork is still pending and you will want to coordinate with the old clearinghouse on getting those ERAs. 
If your ERAs aren’t at the old clearinghouse or Apex, we can open a ticket with them to research what is going on. In order to do that, we will need the following: 
  • 1) Name of the insurance 
  • 2) Check # 
  • 3) Check Amount 
  • 4) Organization Name 
  • 5) Tax ID 
  • 6) NPI 
  • 7) Payment date 
Be aware, that the payer can take several weeks to process these tickets. We will follow up as much as we can though. 
Q: I have been going through my Balances Due You report and realize I have never gotten an ERA for a payment from a couple of months ago – what do I need to do? 
A: Please send us over the following information: 
  • 1) Name of the insurance 
  • 2) Check # 
  • 3) Check Amount 
  • 4) Organization Name 
  • 5) Tax ID 
  • 6) NPI 
  • 7) Payment date 
We will open a ticket with Apex EDI to research the check.  Be aware, many insurance companies put a time limit (typically 60 days sometimes 30 days) on how far back you can request a missing ERA – we will do all that we can to get that electronic version, but you might have to reach out for a paper copy as well. 
Q: I just got approval for ERAs – Is there anyway I can get past payment information electronically, so I don’t have to manage the paper EOB/going to each insurance companies’ website? 
A: Unfortunately, we cannot request ERAs for payments before the paperwork was approved. 
Q: I am not getting any ERAs for an insurance company – I shouldn’t have to provide anything, you just need to fix it. 
A: We understand how frustrating this is – and we want to fix it for you! Many insurance companies won’t communicate the status of ERA enrollment with Apex EDI or My Clients plus though – the only way we can troubleshoot an issue is to track it through a missing ERA file. In order for us to troubleshoot we need: 
  • 1) Name of the insurance 
  • 2) Check # 
  • 3) Check Amount 
  • 4) Organization Name 
  • 5) Tax ID 
  • 6) NPI 
  • 7) Payment date 
If you are missing multiple checks, please send them to My Clients Plus. The more check examples the better. 

Still need help? Contact Us Contact Us