Get the free ERA Enrollment Form

This form is used to enroll providers for Electronic Remittance Advice (ERA) services with Anthem Blue Cross and Blue Shield. It collects information about the provider, their contact details, and

How to fill out era enrollment form

How to fill out ERA Enrollment Form

1. Obtain the ERA Enrollment Form from the relevant authority or website.
2. Fill in the provider's information, including name, address, and NPI number.
3. Indicate the payment method preferences, such as direct deposit details.
4. Provide any additional required documentation or supporting information.
5. Review the form for accuracy and completeness.
6. Sign and date the form.
7. Submit the completed form according to the provided instructions, either electronically or via mail.

Who needs ERA Enrollment Form?

1. Healthcare providers who want to participate in electronic remittance advice (ERA) programs.
2. Billing companies managing claims and payments for healthcare entities.
3. Any organization or individual seeking to receive payments electronically from insurers.

People Also Ask about

What is ERA required?

An electronic remittance advice (ERA) is an electronic data interchange (EDI) version of a medical insurance payment explanation. It provides details about providers' claims payment, and if the claims are denied, it would then contain the required explanations.

What is an era enrollment form?

ERA (Electronic Remittance Advice) is the electronic version of an EOB (Explanation of Benefits). It is common for an insurance company to send a check and EOB when they pay a claim. The EOB explains what payments are included in the check.

What is an ERA document?

Electronic Remittance Advice (ERA) or 835 file is the electronic remittance describing the payer, payee, payment amount, and other identifying information about the payment.

How to do ERA enrollment?

Occasionally, payers must be contacted directly to enroll for ERA. Contact the payer using the information provided by Helper Enrollment team and the payer will provide you with specific instructions to set up ERA. When submitting the paperwork, include every page (instructions and form).

How do I enroll in EFT and ERA?

How do I enroll? Enroll for EFT/ERA through Payment Accelerator: Enroll online for Payment Accelerator, a free service, to start receiving benefits immediately. Or, download the Network Funding Agreement attach a voided check or bank letter and fax them to U.S. Bank toll-free at 1-877-755-3392.

What does ERA enrollment mean?

Electronic Remittance Advice (ERA) The ERA transaction supplies information about. the payment to the health care provider, including any adjustments. to claims and other payments based on factors like: • Contract agreements.

For pdfFiller’s FAQs

What is ERA Enrollment Form?

The ERA Enrollment Form is a document used by healthcare providers to enroll in an Electronic Remittance Advice (ERA) system, which facilitates the electronic delivery of payment information from payers.

Who is required to file ERA Enrollment Form?

Healthcare providers, including physicians, hospitals, and clinics, who want to receive electronic payment information from insurance companies must file the ERA Enrollment Form.

How to fill out ERA Enrollment Form?

To fill out the ERA Enrollment Form, providers must provide their practice information, including National Provider Identifier (NPI), tax identification number (TIN), and contact details, and then submit the form to their respective payer.

What is the purpose of ERA Enrollment Form?

The purpose of the ERA Enrollment Form is to authorize and set up the electronic exchange of remittance advice between providers and payers, streamlining the billing and payment process.

What information must be reported on ERA Enrollment Form?

The information reported on the ERA Enrollment Form typically includes provider identification details, such as NPI, TIN, practice location, and preferences for receiving electronic remittance advice.