Permission level needed to enroll

A TheraNest user with Organization Administrator rights will be needed to enroll providers with Apex Clearinghouse. This person will be the main point of contact for the enrollment process as well. This person will be contacted with any additional enrollment forms or enrollment status with Apex Clearinghouse.

Find out if your payer requires EDI/ERA enrollment

You can view the Apex EDI payer list here. The payer ID for Apex could be different than the payer ID for your current clearinghouse. If there is a green dot under "enrollment required" next to your payer this means EDI enrollment is required. You must be approved by your payer before you can submit claims to them using Apex. Don't worry - you'll still be able to submit claims to this payer through your current clearinghouse while you wait approval. 

EDI and ERA are both types of communication. EDI is permission for the customer/provider to send the claims electronically to the insurance. ERA is permission for the insurance to send the processing information back to the customer/provider.. 

Know how you are credentialed with each of your payers

If you are not 100% sure how you are credentialed with your payer it is very important for you to find out. This will save you a lot of work and time in the future. If you enroll incorrectly you will be rejected and have to complete the enrollment process again for each payer that rejects you. You may be credentialed different with each payer. Some payers you may need to enroll as a group and other payers you may need to enroll each provider individually. We suggest you find this information out before enrollment opens. 

If you submit to Medicare know or find your PTAN Number

You can find your PTAN number on the Welcome Letter you received from Medicare when you were credentialed.  If you can’t find that letter, simply call your provider representative at Medicare and they can give that to you.

Do NOT hold on to claims till you're approved by your payer with Apex EDI

Some payers do not require enrollment and you can start submitting to them right away. However, there are payers that DO require enrollment and we have to wait to be approved by them before submitting. When enrolling with a payer with Apex Clearinghouse it can take up to 45 business days to be approved by some payers. If you are rejected you will need to go through the enrollment process again with your corrections. Because of this and with regard to timely filing we ask that you do NOT hold on to claims until you've received your approval notification from TheraNest. Please do not disrupt your payment and continue to bill as you currently are until you've been approved. Again, do NOT hold your claims. 

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