Enroll Link
2107 North Decatur Road
Suite 449
Decatur, GA  30033

toll free: 866-416-8604
tel: 404-806-3753
fax: 360-283-3321

info@enrolllink.com

"Deploying the Enroll-Link solution allowed us to reduce our EDI enrollment workforce from 16 EDI enrollment specialists to 6 in a matter of months." 

 Vice President of EDI Services
Top Four National
Practice Manager Solutions Vendor

 

"Enroll-Link has allowed us to be more responsive to our client's needs by giving us a way to track follow-up, be proactive in many circumstances, and stay on track during the enrollment process."

Team Lead, EDI Implementation

THE PROBLEM

 

Challenges for the Healthcare Vendor              

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EDI enrollment is a request from a healthcare provider to exchange EDI transactions with a payer. This request almost always requires a provider or officer signature and a form that is specific to the payer with whom the request is being made. Approximately 30% of all payers require this paperwork to be completed, submitted and approved before processing any EDI transactions. 80% of these payers are government and 20% commercial.

The EDI enrollment process can take anywhere from 14 to 120 days depending on the payer connections requested and the enrollment process used. On average a provider will be required to complete and submit at least 4 different payer EDI enrollment forms along with various EDI vendor contracts and agreements. 

The majority of the burden for the EDI enrollment falls on the EDI vendor or clearinghouse who wishes to provide EDI transactions to a provider. A recent WEDI SNIP study revealed that "as much as 20% of Clearinghouse FTEs are dedicated to facilitating payer enrollment". In order to process provider transactions and gain revenue, EDI vendors and clearinghouses must obtain the forms from the payers, assist the providers in completing the forms, track the progress of the forms and make calls to the individual payers to confirm provider enrollment status. When errors occur in the enrollment process, it is the vendor that must clarify and resolve the problem.

Several trends are causing the EDI enrollment process to increase both in volume and complexity. The move towards HIPAA compliance is driving more providers to submit EDI transactions which increases the volume of enrollment processed every year. In some cases HIPAA has caused payers to increase the amount of paperwork required for transaction processing. There is an increase in commercial payers implementing EDI enrollment processes to support new real-time transactions. In most cases, any change in the identity of the vendor submitting a provider’s transactions will trigger a reenrollment of that provider. Industry Growth is impeded by the need to complete the EDI enrollment process.

The current manual EDI enrollment process has created a bottleneck for growth in the annual five billion dollar healthcare EDI transaction marketplace.

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