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PAYER ENROLLMENT INSTRUCTIONS FOR
Before enrolling please be sure your Capario contract includes the transactions you will be using.
Complete the payer enrollment process BEFORE submitting claims to Capario for this payer. If you
are unsure about your contract status please contact Capario Support team at: [email protected] or
800‐792‐5256.
We recommend enrolling using our Portal enrollment tool. This free Portal tool allows you to enter
Providers and select the payers and transactions for your enrollment as it prefills the agreement
forms for you. Another advantage of the enrollment tool is the ability to follow the progress of
enrollments from initial generation through to payer approval. Our team will set you up and provide
a quick tutorial. Contact us at [email protected]
If you are not enrolling with the free portal Enrollment tool, please following these instructions:
If this payer does not require an agreement, go to Step 2. STEP 1: COMPLETE AGREEMENT
Complete all required fields on agreement and verify that information entered is correct.
If an agreement requires signatures, we recommend signing in blue ink. Do not use signature stamps.
STEP 2: PROCESS
Capario Enrollment 1901 E. Alton Ave. #100
Santa Ana, CA. 92705 Phone: (800) 792-5256 Option 1
Fax: (404) 877- 3324 [email protected]
Page 1 of 1 04/27/2015
ERA/EFT Enrollment Instructions for State Farm First Health (31053) This payer requires EFT to receive ERAs. In addition to completing the enrollment posted here you MUST also add the EFT transaction to your Capario account and indicate that you requested EFT with ERA.
There is a two‐step enrollment process. Please follow the detailed instructions below. Step 1 – EFT Enrollment
Go to: https://b2b.statefarm.com/b2barf/jsps/pages/healthContactUs.faces
Complete all required Fields (Provider Information, Provider Address & Provider Contact Information) o The phone number of the provider cannot include an extension for the authentication process;
unfortunately the payer’s website can’t handle an extension.
Additional Information Required ‐ Are you acting on behalf of provider? ‐ select NO from drop down
ERA or ERA/EFT Enrollment, provide the Method of Retrieval – Select Emdeon from drop down
Once the online set up is complete on the State Farm b2b website, an authentication email gets sent out and must be responded to allow the provider access to our secure B2B site, which is where the ERA and EFT Enrollment forms are located.
Step 2 – ERA Enrollment
Complete the Emdeon ERA Provider Setup Form (next page), and send to: Fax: (615) 885‐3713
OR Email: [email protected]
**NOTE** IF YOU PREVIOUSLY RECEIVED ERAs THRU EMDEON YOU MUST ALSO COMPLETE & SUBMIT THE CHANGE OF VENDOR REQUEST. USE THE INSTRUCTIONS PROVIDED BELOW.
Questions? Contact Capario EDI Enrollment at: (800) 792‐5256 Option 1
STEP 3: COMPLETE CAPARIO ENROLLMENT SPREADSHEETS
Capario Provider Spreadsheet – This is completed for each new provider.
http://www.capario.com/downloads/xls/provider_bulk_spreadsheet.xlsx
Capario Payer Enrollment Spreadsheet – This is completed when requesting enrollment with a payer for providers previously added to the Capario system. Please refer to the instruction tab on each spreadsheet form for details about the information to enter in each column.
**PLEASE NOTE** The fields for tracking information are key for both your record keeping of enrollments and for Capario following up with payers for approvals. Be sure to enter all tracking for each enrollment.
http://www.capario.com/downloads/xls/enrollment_bulk_spreadsheet.xlsx
Email the completed spreadsheet(s) to: [email protected]
Questions? Contact us:
Phone: (800) 792‐5256 Option 1 Fax: (404) 877‐ 3324 Email: [email protected]
Revised 01.19.2010
**Section 1** Provider Organization section must be fully completed with Facility/Provider information, failure to complete all fields may result in form rejections. Do not list Vendor or Billing Service information. ERA payer enrollment requires that this information be that of the Facility/Provider as multiple payers will contact the Facility/Provider contact to confirm enrollment. These payers will not accept the confirmation of enrollment from Vendors or Billing Services. Billing NPI is required to complete enrollment.
Emdeon ERA Provider Setup Form
1 Provider Organization
Practice/Facility Name
Tax ID Billing NPI ID
Practice/Facility Address
City State Zip Code
Contact Name Contact Phone Number
Provider Email
2 Vendor (Emdeon contracted & certified customer used to retrieve ERA files)
Vendor Name Submitter ID
Contact Name Contact Phone Number
3 ERA Receiver
Receiver ID
Distribution Method (Must list one method)
Distribution
4 Payer (If additional rows are required for payer ID selection, complete additional ERA Provider Setup Forms.) Following Payers MUST have Legacy ID’s listed to complete Payer Enrollment: SB580-SB690-SKAR0-SKMD0
Payer ID Group ID Individual ID NPI ID Payer ID Group ID Individual ID NPI ID
5 Confirmations (Enter E-mail address)
Confirmations (Enter E-mail address)
Email: [email protected] Fax: (615) 885-3713
EDI Team (800) 792-5256 Opt 1
Capario 650202999
EDI Team (800) 792-5256 Opt 1
650202059
FTP Internet Login ID Proxymed
ERA PSF 05/09
Change of Vendor Procedures for ERA A “change of vendor” (COV) letter is required when an existing Emdeon provider changes software vendors. The letter is required when the provider changes from their existing Emdeon certified software vendor (submitter id) to a different Emdeon certified software vendor (submitter id). Any new ERA Provider Set-Up Form (PSF) sent to Emdeon that requires a Change of Vendor (COV) letter will be considered incomplete without the accompanying letter. Emdeon will notify the provider if the “change of vendor” letter is required but not received. Following are steps required for a provider to change Emdeon certified software vendors: Step #1 Complete a Change of Vendor letter using the interactive template provided.
THE LETTER MUST BE PRINTED ON THE PROVIDER/SITE’S LETTERHEAD AND CONTAIN ALL INFORMATION LISTED IN THE BELOW TEMPLATE.
The Authorization letter (COV) must be signed and dated.
Step #2 Email to [email protected] or fax to 615.885.3713
This COV must be attached to a ERA Provider Set-Up Form (PSF) http://www.emdeon.com/enrollment/index.php - Emdeon Set-Up Forms Step #3 Emdeon will make the change in the appropriate Emdeon systems. Confirmation will be sent to the
individual indicated within the ERA PSF when the set up is complete within 5 business days. Step#4 If you are requesting spilt files you must submit a Merge Group ERA PSF with the COV LETTER.
Signature Required on COV Letter
ERA PSF 05/09
Emdeon Enrollment Department Attn: Enrollment Department – ERA Set Up [email protected] Fax: 615.885.3713
Dear Emdeon
Currently, I am receiving my Electronic Remittance Advice through
I would like to start receiving my Electronic Remittance Advice through Emdeon Corporation using
This change request will also include ALL PROVIDERS associated with this tax ID.
Please carry over all payers associated with the below tax id.
Please move only the payers listed on the attached ERA PSF.
Please accept this letter as my request to change vendors. Following is specific information regarding my practice:
Name: Practice: Address:
Phone #: Contact: Email:
Tax Id: Sincerely, Printed Name Title
Signature Required on COV Letter
