Ensora Apex Electronic Claim Setup

Electronic Claims Setup

Instructions

Step One – Locations

If your practice has more than one location, the following instructions need to be completed for each location.

1. Access Admin > General > Locations > open a location.
2. Complete the following fields:
   • NPI: Enter your billing NPI. Note: This number depends on how your practice is credentialed, enter either the Group NPI (Type 2 NPI) or Individual NPI (Type 1 NPI). 
   • FEIN: Enter your tax identification without dashes (e.g.,1234567890). This populates box 25 of the CMS-1500 form.
   • Address: Enter the physical address of your location. Do not enter a PO Box.
   • Zip Code: Enter your 9 digit Zip Code. Do not use a space or hyphen in the zip code. e.g., 775981234. 
   • Facility Type: Select the option applicable to your practice place of service. i.e. “11 – Office.” This is Place of Service (POS) on claim (CMS-1500 24b.) You can change the POS on the invoice item, if necessary.
   • Billing Provider Name: Enter your billing provider name which should match the name assigned to the billing provider NPI as registered on the NPPES website. https://npiregistry.cms.hhs.gov/search  This name in this field displays in Box 33.
   • Billing Location Claims: If you want a different address to display as the billing location on claims (Box 33) Select needed location in dropdown.
   • Billing Provider ID: Select the EIN or SSN.  Correlates to the earlier FEIN Location field.
   • Claim NPI Entity: Correlates to the earlier NPI Location field. If you entered a group NPI in your Location, select Organization. If you entered an individual NPI in your Location, select Individual.
3. Pay to Address: The Pay to Address cannot be the same as your physical address. Leave this field blank unless you have a different address to enter. Note: This field applies only to electronic claims. Click 'Save.'

Step Two - Practice Preferences

Access Admin > General > Practice Preferences > Practice Claims Preferences.

• Select APEX Edi in the dropdown
• Enter Username and Password provided by Ensora. If you need your credentials, contact Ensora.

Note: The Ensora username must be 15 characters or fewer. A username longer than 15 characters will cause a claim error in Ensora. If your username exceeds 15 characters, contact Ensora.

Step Three - Employee/Roles

1. Access Admin > Employee/Roles > Employees > open the employee that is a provider > Provider Details > Provider ID's.
    
   • The NPI entered should be the individual NPI or Type 1 NPI.
   • The UPIN number may be left blank.
   • The insurance companies (on the lower right side of the menu) are for special case exceptions. Leave blank unless need a payer exception for billing npi on electronic claims or taxonomy for 24j on paper claims. 
2. Click 'Save.'

Step Four - Insurance Companies

1. Access Admin > Vendors/Partners > Insurance Companies. Ensure the following fields have been populated for each insurance company. 
   • Insurance Company Name.
   • Address (only required if not sent electronically).
   • Classification: This field is required for paper claims and pertains to Box 1 of the CMS-1500 form. Please complete accordingly. See Example
   • Claim Submission: If claims for this payer will be sent electronically from RevolutionEHR to the clearinghouse, select Electronic. If the claim will be sent another way (not through the clearinghouse) select either "mail or print." These selections allow you to manually mark these claims as submitted. For any payer that you do not want to create a claim, select None.
   • Payer ID: If you are filing electronic claims a Payer ID is generally required. Please refer to your clearinghouse for payer ID listing requirements.
   • Claim Filing Code: This is required for electronic claims.
      

• Participating Practice: If you accept assignment, check the participating provider checkbox. If you do not accept assignment, you will not check this box and the patient will receive the insurance check. This is Box 27 on the CMS-1500 form.
• NPI Only on claims: If this is checked, then box 24J and 33a will only display the NPI on paper claim. If it is not checked E1 and Tax id will list on 24j and 33b of paper claim.
• User Rendering Provider as Referring: If checked, this automatically enters the rendering provider as the referring provider on the claim (CMS-1500 Box 17). Payer requirements vary; check with the payer if unsure. We recommend checking this for Medicare payers at a minimum. The setting applies to new invoices; add the referring provider manually to invoices created before it was checked.
• Remove matching service facility NPI: We recommend leaving this unchecked. If checked, this removes the service facility NPI from the electronic claim when it matches the billing NPI.

Step Five - Log Out and Log In

1. After completing Steps One through Four, log out of RevolutionEHR and log back in to see the changes.

Additional Information

If your practice is using RevClear, please follow the instructions within the following articles:

• RevClear Auto-Posting: Setup
• Quick Guide - RevClear Auto-Posting