ERA Enrollment

Introduction

Now that you've registered your version of Dentrix with Henry Schein One for ERA processing, it's time to enroll with each insurance carrier with whom you participate, so that you can receive their ERAs. There are essentially five types of enrollment, and the following sections will describe each type.

But before you enroll with the carriers, review the following general steps for enrollment.

General Steps

To begin the ERA insurance carrier enrollment process, complete the following steps. Upon completion and/or approval, you should be ready to receive ERAs.

Open the Dental Connect enrollment services website with the User Name and Password that you received from registering with Henry Schein One.
Under Services, click on ERA Enrollment.
Click the TIN/EIN drop-down menu and select your Tax Payer ID Number (TIN) or Employer Identification Number (EIN).
Click the ADD NEW ERA PAYER button.
In the ERA Enrollment webpage, review its "Add ERA Enrollment" information and how it might affect your choice of insurance carrier.
From the Select Payer drop-down menu, select an insurance carrier (Payer).
If required, click ADD ENROLLMENT and then click OK.
The carrier (payer) should appear in the Current and Pending ERA Enrollments table (below), where you can view carrier information, the date your requested enrollment, it's current enrollment status, and a column to download additional forms. (Note: selected automatic-enrollment types won't display in this table until the next day after you select them, and only if you are currently submitting eClaims to the carriers.)

Note: When you select a carrier (step 7), "Special Instructions" may be displayed. These instructions are specific to the selected carrier, and you should pay particular attention to it.

Enrollment Types

The following sections address common types of carrier enrollments which you will likely encounter.

Simple Automatic Enrollments

If you select a carrier that is a simple automatic enrollment type, you don't need to do anything other than select it. (However, you must be submitting eClaims to the carrier for the automatic enrollment to take effect.) Your enrollment is complete, and you should begin receiving ERAs from this type of carrier within one week to 30 days.

The following image is an example of a simple automatic enrollment. Notice that the special instructions state the following: "ERA enrollments are completed on a daily basis automatically by Dental Connect." Therefore, your carrier selection will not display in the Current and Pending ERA Enrollments table until the next day and only if you are currently submitting eClaims to the carrier.

Once the carrier is added to the table, the status displays as "CIH Pending Complete". (Also, you cannot select the ADD ENROLLMENT button for this type of enrollment, as enrollment is automatic.)

Additional Paperwork Enrollments

With this enrollment type, the carrier requires additional "paperwork," such as a completed and signed form, to complete the enrollment. After clicking the ADD ENROLLMENT button, you will be redirected to a webpage where you can download the additional paperwork (see below). Follow the directions on the form, sign it, and return it to the carrier. For help with the form, contact the carrier directly.

When this type of enrollment is selected, the carrier is added to the Current and Pending ERA Enrollments table, and the status displays as "Pending CT Payor".

Practice-to-Carrier Enrollments

In this type of enrollment, your practice must enroll with the carrier directly. The "Special Instructions" state how to contact the carrier (usually by hyperlink) and states pertinent information that you'll need to complete the enrollment. For enrollment help, contact the carrier directly.

Once you click ADD ENROLLMENT, the carrier is added to the Current and Pending ERA Enrollments table, and the status displays as "Initial Request".

Third Party Processing (TPA) Enrollments

With this enrollment, the carrier requires that you use their assigned third-party company to complete the enrollment process, by clicking on a hyperlink to them. Once you complete and submit their forms, the third-party company will notify Dental Connect of their decision about your enrollment. For help with this process, contact the designated third-party company directly.

Once you click ADD ENROLLMENT, the carrier is added to the Current and Pending ERA Enrollments table, and the status displays as "CIH Pending Complete;" however, your enrollment is not complete until the third-party company receives your application and approves it.

Council for Affordable Quality Healthcare (CAQH) Enrollments

CAQH is a specialized third-party, nonprofit organization that facilitates the enrollment process between your office and specific carriers. It also ensures that you and the carriers follow the federal government's CORE industry requirements for insurance services. To enroll through CAQH, select a qualifying carrier, go to the CAQH website, and complete the enrollment process. For help with CAQH enrollment, contact them by email at efthelp@Enrollhub.CAQH.org or call 844-815-9763.

Note the following regarding CAQH enrollments:

CAQH requires that you to be set up for Electronic Funds Transfer (EFT) before you can enroll for ERAs with your selected insurance carrier.
When selecting their "Method of Retrieval" for ERAs, choose Clearinghouse.
Select Emdeon Business Services, as the ERA clearinghouse.
CAQH may ask for a Trading Partner ID; however, it's not required, and you can skip it.

You cannot select the ADD ENROLLMENT button for this type of enrollment because you must enroll through CAQH.

What's Next

After you enroll with an insurance carrier, you should ultimately receive a response within 24 hours to 31 business days, depending on the carrier and enrollment type. Their answer will appear in Dental Connect's website, and the status of your request will display as either "Request Approved" or "Request Denied". Once an insurance carrier approves your request, you should start to receive ERAs within a few days to a few months, depending on the carrier.

Key Information

The user name from the Welcome Letter is also your eClaims User ID. And the Password email has a temporary password that you should change after you access Dental Connect's website. (Refer to the previous lesson in this Quick Start for help with the Welcome Letter and Password email.)
In some cases, enrolling with one carrier may automatically enroll you with all carriers of its parent company. For example, enrolling with Delta Dental of Wyoming automatically enrolls your practice with its parent company, Delta Dental, and all carriers associated with Delta Dental.
Note the following regarding Dental Connect's TIN/EIN drop-down list and your resulting TIN or EIN information:

You will need a TIN, an EIN, or both to register with insurance carriers; however, you will need to execute the enrollment process for each current TIN/EIN that your office utilizes.
After you register with Henry Schein One eServices Sales, they will automatically identify your practice's TINs/EINs and send them to Dental Connect, so that they will display in the drop-down list.
If you have a TIN/EIN that is not in the drop-down list, call eServices support at 800.734.5561, option 1.
TINs/EINs that you no longer use will still display in the drop-down list because they may be attached to claims that have not yet been processed. Make sure that you do not select any TINs/EINs that you no longer use.
The data in the Tax ID Information field should match the TIN/EIN that you selected and be the same information that's included in the claims that you submit to your carriers. If any of your information does not match, is incorrect, or needs to be updated, notify Henry Schein One eServices Enrollment via email at accountupdate1@henryschein.com or call eServices support at 800.734.5561, option 1. However, you can continue to enroll with insurance carriers and update this information later.

The Trading Partner ID, which some carriers require, is a "catch-all" phrase for such things as Provider ID, Legacy ID, Submitter ID, Receiver ID, Clearing House Number, etc. If you have a number that resembles any of these, enter it in the Trading Partner ID field.
An Electronic Funds Transfer (EFT) is an optional payment method that some offices utilize to allow insurance carriers to transfer payments to your practice's bank accounts electronically. Note the following regarding EFTs:

When you select an insurance carrier on Dental Connect's website, the carrier may require you to enroll in an EFT service.
Henry Schein One does not offer an EFT solution; however, their partner Dental Connect does. If you want to enroll in an EFT service with Dental Connect, select the Get Started button (below EFT) in Dental Connect's website (after you log in). However, you are not limited to using Dental Connect, as you can enroll in any company's EFT service.
The Special Instructions on the ERA Enrollment webpage may state the following: "Electronic Fund Transfer (EFT) is not required to participate with ERA." However, even though this may be stated in the instructions, a carrier may still require you to use an EFT service. If you need clarification about a carrier's requirement for EFTs, contact the carrier directly.

If your ERA enrollment with the payer is denied, and the reason is not noted in Dental Connect's website, you should contact the carrier directly to determine the reason for their denial.
ERAs will not be transmitted to your office as soon as you submit claims. There will be a lag time, as the carriers need to review and process your claims before ERAs are created and transmitted to your office.
Also, an ERA is most often received before payment is received from the insurance carrier.
Enrolling for ERAs does not mean that paper ERAs (EOBs) will no longer be sent to your office. Depending on the carrier, some will send both. Also, "automatic-enrollment" carriers typically don't stop sending paper ERAs. As good practice, train your staff not to process both types, as you don't want the payments to be entered twice into the Ledger.
Contact eServices support at 800.734.5561, option 1, for any support related questions and/or for the following situations:

To delete your initial request for a carrier, after you added it to Dental Connect.
To delete a carrier from which you no longer want to receive ERAs.