Medicare claim errors and enrollment issues can hinder the smooth processing of claims and remittances. This guide explains how to resolve common errors, including NPI-related eligibility issues, and outlines the process for enrolling a provider for e-claims and electronic remittance advice (ERA).
Provider NPI Not Enrolled for Eligibility with Payer
This error is typically triggered when the provider's NPI (National Provider Identifier) is not adequately enrolled or authorized for Medicare eligibility (HETS) transactions with the designated payer.
How to Resolve This Error
To ensure Medicare claim eligibility, follow these steps:
Credentialing the NPI with Medicare: - Ensure that the provider's NPI is credentialed with Medicare and that they have an active PTAN (Provider Transaction Access Number).
Completing HETS Attestation: - Log in to your EDISS account. - Navigate to the "Manage HETS Attestation" section and create a new attestation record. - Enter Claim.MD's Unique ID: UTUX. - Agree to the terms and submit the attestation.
Enroll NPI on a National Level: - Ensure you complete Medicare eligibility enrollment for only one state, as Medicare eligibility is processed nationally.