Enrollments
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      Enrollment Inquiries & Requests

      WARNING!!

      Please do not send requests for new enrollments, enrollment status or missing remits to any individual members of the enrollments team via direct email. Please ensure you are creating an enrollments ticket within HubSpot.

      Enrollment Status or Claim Rejections/Denials for Enrollment:

      1. Open HubSpot ticket as follow
        1. locate the company (Parent company unless you need a child practice enrolled- if unsure use parent company record)
      2. Populate the properties on your ticket per the below
        1. Ticket Name: Enrollments – AE Support/Practice Name 
        2. Pipeline: Enrollments
        3. Ticket Type: Enrollments
        4. Description :should include whether it is for an enrollment status or claim rejection
        5. Source: blank
        6. Ticket Owner – Name of ticket creator
        7. Priority: Medium
        8. Click create ticket
          Please include all details in your snippet as follows

      Snippet Instructions

      To use the Snippet for note template follow these instructions:

      1. Click "Create Note"
      2. in the note type #enroll
      3. Click enter
      • Payer name 
      • Payer ID 
      • Clearinghouse
      • Clearinghouse rejection message
      • Tax ID 
      • Patient ID number from PMS
      • Screenshot if related to rejection or denial (no PHI)
      • Any troubleshooting, additional info or actions already taken (did you reach out to your team handling rejections? and what was outcome?)

      Missing/Misrouted ERA

      If you find that the enrollment has been completed and you are missing or misrouted remits please refer to the MIssing/Misrouted ERA SOP 

       NOTE: A payment is required to complete research; IE: if there is no payment within the last 15 days there will be no remit produced.  Thank you.

      Request Addition of Payer ID to Kareo System:

      Requests to add a new payer ID to Kareo you will need to create a data services ticket as follows

      From the company record click + Add Ticket

      • Ticket name: "Data Service - Company Name"
      • Pipeline: Data Services
      • Ticket Type: Data Services
      • Ticket Description: Request to add Payer ID into Kareo system
      • Source: select most applicable way the software issue was reported (email, phone, chat, etc.) if one does not apply leave blank.
      • Priority: select Low, Medium or High
      • Create date: should always be the date you create the ticket.
      • ensure company name is listed
      • select appropriate contact person for the account.
      • click CREATE

      From this ticket you will send an email to enrollments@kareo.com using the email template  in HubSpot. The template is called “Add Payer ID into Kareo”  

      The following must be filled out in the email template:

      • Payer name
      • Payer address
      • Payer ID for the clearinghouse Zirmed/Waystar.

      Ticket actions needed

      1. After your email is sent per the above, you will receive an automated response via email. Document this case number within your ticket under "Data Services" section of your ticket. Add to "Kareo Case ID"
      2. Check off action for "Notification of Kareo data support sent"
      1. When you receive a response from Kareo check the box for "Received Kareo Response"
      2. Also fill in the date under "Kareo data services support response date"
      3. Once resolved check "Resolution Received"
      4. If EDI enrollment is required, please create an Add on enrollment ticket for the enrollments team with all the required documentation.

      Request a New or Add on Enrollment:

      In order to request add on enrollments for an existing customer you will need to create a ticket for the enrollment team.

      Tickets for new or add on enrollment can be created by any Health Prime team member

      Creating the ticket:

      1. Open HubSpot ticket as follow

        1. locate the company (Parent company unless you need a child practice enrolled- if unsure use parent company record)

      2. Populate the properties on your ticket per the below

        1. Ticket Name: Enrollments – Request for  New or Add on 

        2. Pipeline: Enrollments

        3. Ticket Type: Enrollments

        4. Description Request for New or Add on enrollments

        5. Source: blank

        6. Ticket Owner – Name of ticket creator/advisor/Ops consultant

        7. Priority: Medium

        8. Click create ticket

          Within the ticket please update the following:

          1. Enrollment Type: This will depend on the type of add on enrollments you need

          2. Payer ID: here you will enter the payer id’s you wish to enroll

          3. Payer Name: Here you will enter the payers name

          4. Kareo ID: (if Applicable)

      Upload a copy of the completed enrollment request form to the shared folder with all required documents and information

      Enrollment Request Form

      Sharefile: Remember, any documents with sensitive info like account numbers, signatures, etc. should be uploaded to the share-file not the ticket. Thanks. 

      Required Information 

      Please ensure you have entered in any required provider numbers

      Upload all required documents if applicable to your enrollment request to the following directory for Internal Staff enrollment documents.

      https://hpi365.sharepoint.com/:f:/s/EnrollmentsShared/EmCOGRlhLppAhcdkF-kPLn8BldtnNTC8XeUQgONXJ1ckyQ?e=EElBEc

      List of required documents

      • Copy of voided check (ERA & EFT)

      • TAF

      • Payer portal logins (payspan, optum, instamed, etc)

      • Completed Enrollment form (provider numbers when applicable)

      When uploading your documents into the Internal Staff folder please include the ticket number, practice name and the KID in the document label.

      Example: Ticket12344566practicename+(KID if applicable)

      Note: All required documents must be uploaded to the internal staff shared folder, at no time are we ever to house this information within HubSpot

       

      IMPORTANT: Once you have uploaded all documents in Share file (link above) please mark "Enrollment Form Complete" YES in your ticket to notify enrollments its ready to be worked. 

      Important Ticket Processing Information 

      Once the request is received the enrollments team will verify, we received all required information to initiate the enrollments and create the corresponding enrollments payers tickets. If the required information to complete the enrollments is not received the enrollments team will return the ticket to the creator. This will allow the creator to obtain the missing required information, the information must be returned within 48 hours of notification. If the information needed to initiate the enrollments is not received by the enrollments team within the 48 hours, you will be notified via email we did not receive the required information to initiate the enrollments and the ticket will be closed. 

      If your ticket is closed for missing required information you will need to create a new enrollment ticket for processing.

      To review how to best add an insurances to the software please review the resources listed below:

      Kareo

      Add Insurance to an account: https://helpme.kareo.com/Platform/Practice_Settings/Insurance/Add_New_Insurance_Company%2F%2FPayer_-_Non-EDI 

       

      Payer Portal Info:

      Payspan: the email address on file gets a security code before allowing access. If this can be changed to the PMBenrollments@hpiinc.com  while the enrollment is processing to ensure enrollment is completed correctly. Once completed KMB Enrollments will then change it back to the practice owner/ biller or administrator, whomever will own this portal access.

      Optum: the ERA enrollments are internal through the clearinghouse. Optum will send an email to the enrollment contact on file with the payer to authorize the clearinghouse to receive your ERAs. If you do not respond within 3 days of this email, your request cannot be processed. A change of vendor letter must be sent in with the specific payers listed at that time and the waiting process for them to come in electronically begins.

      Payplus or Zelis will charge a fee for the EFT service they provide. Some clients refuse to activate Zelis as to avoid the fees associated. https://www.zelispayments.com/

      Molina enrollments are through this specific portal that we need access to in order to enroll. https://providernet.adminisource.com. In addition we also need a payment that has been issued within the last 30 days in order to process the enrollment.

      In order to verify if your ERA/EFT enrollment requires portal access please review the following links below for each portal.