CNIC Health Solutions

PAYER ENROLLMENT INSTRUCTIONS FOR 37227
CNIC Health Solutions - ERA
Before enrolling please be sure your Capario contract includes the transactions you will be using. ERA Transactions
are available as an additional Capario contracted service. Please ensure you are contracted
with Capario
to request Electronic Remittance BEFORE requesting ERAs through Capario for this payer. If you
Complete the payer enrollment process BEFORE submitting claims to Capario for this payer. If you are unsure about your current status please contact Capario sales at: sales@capario.com or 800-586-6870.
are unsure about your contract status please contact Capario Support team at: edi@capario.com or 800‐792‐5256. EFT enrollment
and transmission is an arrangement between the provider and the Payer. If the Payer offers EFT
transactions contact them to determine if they:
• Require
you to receive EFTs in order to receive their ERAs
We recommend enrolling using our Portal enrollment tool. This free Portal tool allows you to enter • Charge
an
additional fee for EFTs/ERAs
Providers and select the payers and transactions for your enrollment as it prefills the agreement • Require you to enroll for EFTs on this ERA enrollment form.
forms for you. Another advantage of the enrollment tool is the ability to follow the progress of We recommend
enrolling using the convenience of our enrollment tool located on the Capario portal. This tool
enrollments from initial generation through to payer approval. Our team will set you up and provide allowsa quick tutorial. Contact us at edi@capario.com you to enter providers, select the payers and transactions for which you want to enroll, and produces
pre-filled forms for processing. If you are not currently using the Capario portal, you can contact us at
sales@capario.com and our team will ensure that you are set up and will provide a quick tutorial on using the
enrollment tool.
If you are not enrolling with the free portal Enrollment tool, please following these instructions: Enrollment can be completed without the enrollment tool by following the specific instructions for this payer shown
If this payer does not require an agreement, go to Step 2. below.
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 This payer requires that you enroll for EFT in order to receive ERA. You must complete the
EFT approval process 'PRIOR' to submitting the Emdeon ERA Provider Setup Form. Please
follow the detailed instructions on the page below.
**NOTE: Provider must obtain the Provider ID directly from the payer and enter the Provider ID
under the Trading Partner ID Field on the form before submitting.
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: provider.enrollment@capario.com Questions? Contact us: Phone: (800) 792‐5256 Option 1 Fax: (404) 877‐ 3324 Email: provider.enrollment@Capario.com
Capario Enrollment
1901 E. Alton Ave. #100
Santa Ana, CA. 92705
Phone: (800) 792-5256 Option 1
Fax: (404) 877- 3324
provider.enrollment@Capario.com
EFT/ERA Agreement Instructions for CNIC Health Solutions Inc. (37227) CNIC Health Solutions Inc. requires providers to be approved for EFT prior to requesting ERAs. The enrollment process is as follows: 1) Complete and sign the EFT Enrollment and Authorization form. 

E‐Mail: EFTEnrollment@Emdeon.com
Once your enrollment has been processed you will receive an email from Emdeon. Also, Emdeon will make a small deposit in your designated bank account with the reference note “EFT Enroll”. You will need to call (866) 506‐2830 to confirm the deposit amount. You must verify receipt of this deposit to activate your EFT. **NOTE: If the provider is already setup for EFT with Emdeon and has enabled banking, an EFT Payer Add/Change/Delete online Form is what should be used,not the EFT Enrollment Form supplied on the next pages. o To complete the Add/Change/Delete Online form go to: http://www.emdeon.com/epayment/enrollment/EFTPCF.php 2) After confirming EFT, please complete the Emdeon ERA Provider Setup Form Fax: (615) 885‐3713 Email: batchenrollment@emdeon.com 3) Update your Capario enrollment to indicate that EFT has been approved and PSF has been sent, (use check point ‘Sent to Payer’). **NOTE** IF YOU PREVIOUSLY RECEIVED ERAs THRU EMDEON YOU MUST ALSO COMPLETE AND SUBMIT THE CHANGE OF VENDOR REQUEST. PLEASE USE THE INSTRUCTIONS PROVIDED ON THE EMDEON CHANGE OF VENDOR PROCEDURES FOR ERA FORM.
Questions? Contact Capario Enrollment at: (800) 792-5256 Option 1
Page 1 of 1
Last Revised: 06/01/2015
This Request is for 37227 ONLY
37227
CNIC Health Solutions Inc.
Page 1 of 3 Questions? Call 866.506.2830 (Option 1) for assistance X
Page 2 of 3 Questions? Call 866.506.2930 (Option 1) for assistance X
Page 3 of 3 Questions? Call 866.506.2830 (Option 1) for assistance Emdeon ERA Provider Setup Form
1
Email: batchenrollment@emdeon.com Fax: (615) 885-3713
Provider Organization
Practice/Facility Name
Tax ID
Billing NPI ID
Practice/Facility
Address
City
State
Contact Name
EDI Team
Contact Phone Number (800) 792-5256 Opt 1
Provider Email
Provider.Enrollment@Capario.com
2
Vendor
(Emdeon contracted & certified customer used to retrieve ERA files)
Vendor Name
Capario
Contact Name
EDI Team
3
Zip Code
Submitter ID
Contact Phone Number
650202059
650202999
(800) 792-5256 Opt 1
ERA Receiver
Receiver ID
650202059
Distribution
Method
Distribution
Proxymed
FTP Internet Login ID
(Must list one
method)
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
37227
5
Confirmations
(Enter E-mail address)
Confirmations
(Enter E-mail address)
Provider.Enrollment@Capario.com
**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.
Revised 01.19.2010
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.
THELETTER
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THEPROVIDER/SITE'S
PROVIDER/SITE’SLETTERHEAD
LETTERHEAD
THE
ANDCONTAIN
CONTAINALL
ALLINFORMATION
INFORMATIONLISTED
LISTEDIN
INTHE
THEBELOW
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AND
The Authorization letter (COV) must be signed and dated.
Step #2 Email to batchenrollment@emdeon.com 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.
ERA PSF 05/09
Emdeon Enrollment Department
Attn: Enrollment Department – ERA Set Up
batchenrollment@emdeon.com
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
Capario
This change request will also include ALL PROVIDERS associated with this tax ID.
Please carry over all payers associated with the below tax id.
X
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
ERA PSF 05/09