Client Web Enrollment Instructions

Please read contents to enroll providers and/or billing center for ENS services to include electronic claims, eligibility verification, referrals & authorizations, electronic claims tracking (ECT), and claim status. If you complete the web enrollment worksheet prior to online enrollment, you will have all the information necessary for data entry. Your software vendor has been assigned a special URL number, and you must use their URL to get their pricing link. Your software vendor should have a link on their website to access ENS web enrollment. If not, please contact software vendor for their URL link.

Adobe Acrobat Reader version 6.0 or higher is required to printout contract and EMC agreements. The software is free from their website .

ENS Contact: Benjamin Bowling

800-341-6141

904-778-9580

Table of Contents

1. Preparation for web enrollmentPage 3

2. Access to ENS web enrollmentPage 3

3. New web enrollment

3.1 Create order number Page 3

3.2 Enter demographic information for organizationPage 3

3.3 Enter qualification informationPage 3

3.4 Select type of productPage 3

3.5 Select recommended systemPage 4

3.6 Select type of payment for up-front fee (credit card or check)Page 4

3.7 View and printing of contract (System Service Agreement)Page 4

3.8 Group enrollment Page 4

3.9 Enroll doctorsPage 4

3.10 EMC agreementsPage 4

3.11 Schedule setup for installationPage 4

3.12Confirmation of contract to complete web enrollmentPage 4

4. Return to complete an orderPage 4

5. Adding or changing provider information after web enrollmentPage 5

6. Up-dating insurance library in practice management systemPage 5

7. Customer center Page 5

8. EMC agreement follow-up with payersPage 5

9. How non-approved state payer claims are handledPage 5

10. Patient StatementsPage 5

11. ERA enrollmentPage 6

12. Helpful hintsPage 6

13. Useful websitesPage 6

14. ENS contactsPage 6

15. Client web enrollment worksheets Pages 7,8,9

16. Exhibit A – ENS services pricingPage 10

17. Schedule B – Multiple provider and by claim volume pricing Page 11

18. Web enrollment and installation checklist Page 12,13

Instructions for Completing ENS Web Enrollment

Preparation for web enrollment:

  1. Check with software vendor for website link to ENS web enrollment.
  2. New billing center must have a provider to enroll for ENS services.
  3. You must have an internet connection
  4. You must have a compatible web browser to access the ENS website
  5. *Complete web enrollment worksheet
  6. Review Exhibit A / Schedule to determine how ENS will bill you for services
  7. Worksheet used only to assist you with web enrollment.

Access to ENS Web Enrollment

  1. Use vendor website link: (Hold the Ctrl key and click the link).

New Web Enrollment

Order Number

  1. From the completed worksheet, enter the organizational phone number. This sets up an order number in the system. Never use the same phone number for already established accounts because it over-writes existing information. Example: Billing center should use provider office number if keeping accounts separate for tracking purposes.
  2. Depress “Continue” key

Demographics Screen

  1. Enter organizational information about your practice or billing center.
  2. Verify your software vendor is correct. If not, close your internet connection and start over.
  3. How did you hear of these services requires an entry. Use ‘website’ if nothing else is applicable.
  4. Sales help requires no entry – depress “Continue”
  5. Verify the organizational information is correct. Make corrections if applicable.
  6. Depress “Continue” key

Qualification Screen

  1. Use drop down to select practice management system. Select “unknown” if not known, then type in name for second entry.
  2. Select type of claims either “Professional / HCFA1500” or “Institutional / UB92”
  3. Answer “Yes” or “No” to using an internet connection
  4. Answer “Yes” or “No” to sending patient statements

Product Selection Screen

  1. You must select a claim volume
  2. You must enter the number of providers enrolling
  3. Automatic selection is “gold” for level of service – includes unlimited claims, eligibility verification, electronic claims tracking, referrals/authorizations, and claim status.
  4. Options for level of service – only (1) level of service is permitted

Standard – Unlimited claims only

Claims w/ECT – Unlimited claims + electronic claims tracking (ECT)

Volume Gold – Each 200 claims, eligibility, ECT, referrals/authorizations, and claim status

Volume Standard – Each 200 claims only.

Per claim

  1. Depress “Continue” key

Recommendations Screen

  1. Select the applicable format for claim submission (WinHecet, Health-e Claim, NSF, ANSI)
  2. Check with software vendor to verify how claims are sent

Payment Screen

  1. The initial fee and first month’s recurring fee are collected up-front.
  2. Enter credit card or check information as source of payment
  3. Depress “Continue”

Print and View Screen

Requires Adobe Acrobat Reader 6.0 or higher. Select Adobe Reader to download if required

1. Select printer icon to print the contract

2. Close printer

3. Select “I agree” to accept the contract. “Do not agree” cancels contract.

Group Enrollment

  1. Enter group payer id’s if applicable
  2. Depress “Save &Continue” to either skip or finish group enrollment

Enroll Doctors

  1. Organizational contact will appear as “contact” on the doctor screen
  2. Certain organizational information is input into doctor fields. You can delete and insert correct doctor information if necessary. Example: Billing centers require changing address, phone numbers, etc.
  3. Always “Save Doctor” information. Each doctor is added to the screen for your review. Use edit to change doctor information.
  4. Important that all provider information is entered correctly.
  5. Select “Continue” after all doctors have been entered.

EMC Agreements

  1. These are agreements between the state payers (BC/BS, Medicare, Medicaid, Tricare, etc.) and the provider office that allows ENS to be a third party for electronic claims submission.
  2. You can print the EMC agreements during web enrollment. An option is to retrieve the EMC agreements from the ENS website , select “DownLoadCenter”, select EMC agreements, enter your “user id” which is provided within 48 hours of web enrollment, and then select the state required.
  3. ENS has implemented bar-coding of EMC agreements to decrease processing times since we are able to track the agreements as they move through the approval process. Your user id is embedded in the bar code; therefore, the necessity to printout the agreements with the correct user id is critical.
  4. EMC agreements must be completed and signed by the doctors with blue ink pen. Original look is required.
  5. Agreements must be forwarded to ENS Corporation, 7899 Lexington Drive Suite 203, Colorado Springs, CO 80920. Attn: Enrollment Department

Schedule Setup Screen

  1. Select day and time for installation.
  2. Please allow (2) weeks for installation request.

Confirmation Screen – (3) options

  1. Confirm this order – completes the web enrollment
  2. “Stop and return later” – Order number and password required to complete contract.
  3. “Void” – Cancels the contract and voids payment.

Return To Complete An Order

  1. Access the ENS web enrollment website using software vendor URL
  2. Select “Return to Complete An Order”
  3. Enter the order number
  4. Enter the password

5. Complete the contract

Adding Or Provider Changes After Web Enrollment Completed

  1. From the ENS website
  2. Select “DownloadCenter”
  3. Select provider change form
  4. Select payer enrollment form
  5. Complete and fax to the enrollment department at 877-630-2064

* This applies to billing centers adding providers to an existing user id.

Important To Up-date Insurance Library In Your Vendor Software

  1. ENS payer list located at
  2. Select payer list then medical payer list
  3. You must up-date your vendor software to match ENS payer list
  4. Print image users (WinHecet or Health-e Claim) should use the “Enter As” payer descriptor or contact software vendor for help placing the payer id onto the claim form.
  5. NSF or ANSI submitters will use the payer id for identification for the claim file
  6. This must be done to assure a clean claim file

CustomerCenter

  1. From ENS website
  2. Select “Customer Support”
  3. Select “Sign In”
  4. Enter “User Name” and “Password” provided by software vendor
  5. Select EMC agreements

Select provider to review EMC status whether approved, pending, or rejected

  1. Or select incidents

Allows you to view status of incidents or create incidents

EMC Follow-up With Payers

  1. Responsibility of provider office to follow-up on EMC agreements to expedite approvals on a timely basis.
  2. ENS must have approval from state payers prior to electronic claim submissions
  3. Do not include non-approved payer claims in the electronic claim file
  4. Provider office should contact ENS at 800-341-6141 option 4 when approval is received to verify that ENS has also received the approval letter or fax to 877-630-2064 Attn: Enrollment Department

Non-approved Payer Claims

  1. Submitted claims are placed in a “hold file”
  2. These files are released into production once approvals are received by ENS
  3. The hold files must be purged, usually (45) days if no approval, but you are notified prior to purging the files thru our message center.
  4. ENS can either delete these files for you or print the claims to paper for $0.43 per paper claim.
  5. You can notify the enrollment department (fax number 877-630-2064) not to hold claims, but submit them as paper claims at $0.43 per paper claim.

Patient Statements

  1. An optional service offered by ENS
  2. Forms are on ENS website under “DownloadCenter”, select patient statement setup sheet for print image (WinHecet) if upload utilizes modem, or select IXT patient statements enrollment form for use with internet service.
  3. Patient statements require a postage deposit based upon the number of statements x $0.58
  4. Vendor software must be able to create a print image file or text file for this service.

ERA Enrollment

  1. Electronic remittance advice is an optional service
  2. ERA payer list is available , select payer list, then select ERA payer list
  3. ERA is priced as an additional monthly charge as per Exhibit A / Schedule B
  4. Requires ERA web enrollment on ENS website. Select “Enroll Online ERA”
  5. Requires you to enroll for ENS claim service first since “User Name” and “Password” provided by software vendor are necessary to complete ERA web enrollment.

Helpful Hints!

  1. Important: There is a timeout feature within the web enrollment process. If no entry is made within a certain time frame (20 minutes), the web enrollment will time out; therefore, all information for enrollment must be re-entered. If you need to leave web enrollment, it is best to stop and save. Remember, you must write down the order number and password which is used to return to complete order.
  2. Important: Printing out the System Service Agreement and agreeing to the terms of the agreement does not constitute completion of the contract. The last screen for web enrollment (confirmation screen) asks you to confirm, save, or void the order. Until this is done, you have not completed web enrollment.
  3. Important: There are numerous forms and training aids on the ENS website at . Some selections will require a user id which is supplied by your software vendor. You can visit the ENS training library to familiarize yourself with procedures for various ENS services such as eligibility checking, electronic claims tracking (ECT), claim submissions, etc.

Websites

  1. ENS home page
  2. ENS demo
  3. ENS web enrollment Vendor URL 626
  4. ERA manual

ENS Contacts:

  1. Questions concerning enrolling, pricing, and procedures.

Benjamin Bowling, , 800-341-6141 Direct: 904-778-9580

  1. Questions after web enrollment completed.

Cheryl Kuzemka, , 800-341-6141 x1392

  1. Questions with completing EMC agreements

, 800-341-6141 option 4

Client Web Enrollment Worksheet

Vendor URL Link: <Insert Vendor URL

* Adobe acrobat reader 6.0 or higher is required to printout contract and EMC agreements

Provider Office or Billing Service Information:

  • New service is established utilizing the organization phone number. Acts as an account number.

Organization Name: ______

Address: ______

City: ______State______Zip ______

Phone:______Fax ______Tax ID ______

E-mail Address: ______

Primary Contact: First Name:______Last Name:______

Monthly Claim Volume: ______Number of providers in office being enrolled ______

Initial Fee:

[ ] Quote by software vendor

Recommendation Questions

What is the name of your practice management software? ______

Other ______

1.What type of claims will you be submitting electronically? [ ] Professional [ ] Institutional

2.Do you want to access reports, perform eligibility & ECT over internet? [ ] Yes [ ] No

3.Do you want to send patient statements electronically? [ ] Yes [ ] No

Monthly recurring fee based upon number of providers: Number of providers: ______

[ ] Gold *[ ] Claims with ECT [ ] Standard

$69 – 1st Provider $59 – 1st Provider $49 – 1st Provider

Unlimited claims, ECT, eligibility, referrals Unlimited claims, ECT Unlimited Claims

Internet connection required Internet connection required BBS or Internet

Optional monthly recurring fee based upon claim volume: Monthly claim volume ______

[ ] Volume Gold [ ] Volume Standard

$69 – 1st 200 Claims $49 – 1st 200 Claims

Includes ECT, eligibility, and referrals Claims Only

Internet conection required BBS or Internet

Optional per electronic claim versus monthly recurring fee:

[ ] Each electronic claim $0.35

Minimum monthly fee is $29.00

Optional Services: Additional paperwork required:

[ ] Per electronic paper claim $0.43 [ ] Patient Statements $0.58

[ ] Non-participating eligibility per transaction $0.35 [ ] Each Additional Page $0.18

[ ] Per UB92 electronic claim $0.35 [ ] Each Custom Statement $0.04

Select format for claims submission:

[ ] WinHecet [ ] Health-e Claim [ ] NSF 320 [ ] NSF 3.0 [ ] NSF 5.0 [ ] ANSI 837P [ ] ANSI 837i

Print Image Print Image Professional Professional Institutional Professional Institutional

Payment Information: Select method of payment for initial fee + first months recurring fee in advance. Once active the recurring fees are invoiced on a monthly basis for payment.

Credit Card Information:

[ ] VISA [ ] MC [ ] AMEX Card Number ______Security Code ______

Expiration Date: Month ______Year ______

[ ] Check Information:

Bank Name: ______

ABA Routing Code: ______Account Number ______

Group ID Numbers: Group tax ID number: ______

Blue Cross #______Medicare #______

Blue Shield #______Medicaid #______

1st Provider Information:

First Name: ______Last Name: ______

Tax ID #: ______Phone # ______Fax # ______

E-mail address: ______

Address 1: ______

Address 2: ______

City: ______State: ______Zip: ______

Blue Cross# ______Blue Shield# ______

Medicaid # ______Medicare # ______

Champus (Social Security #) ______UPIN # ______

MCC Behavioral______RR Medicare______

Other ______#______Other______#______

Other ______#______Other______#______

Specialty ______

2nd Provider Information:

First Name: ______Last Name: ______

Tax ID #: ______Phone # ______Fax # ______

E-mail address: ______

Address 1: ______

Address 2: ______

City: ______State: ______Zip: ______

Blue Cross# ______Blue Shield# ______

Medicaid # ______Medicare # ______

Champus (Social Security #) ______UPIN # ______

MCC Behavioral______RR Medicare______

Other______#______Other______#______

Other______#______Other______#______

Specialty ______

3rd Provider Information:

First Name: ______Last Name: ______

Tax ID #: ______Phone # ______Fax # ______

E-mail address: ______

Address 1: ______

Address 2: ______

City: ______State: ______Zip: ______

Blue Cross# ______Blue Shield# ______

Medicaid # ______Medicare # ______

Champus (Social Security #) ______UPIN # ______

MCC Behavioral______RR Medicare______

Other______#______Other______#______

Other______#______Other______#______

Specialty ______

4th Provider Information:

First Name: ______Last Name: ______

Tax ID #: ______Phone # ______Fax # ______

E-mail address: ______

Address 1: ______

Address 2: ______

City: ______State: ______Zip: ______

Blue Cross# ______Blue Shield# ______

Medicaid # ______Medicare # ______

Champus (Social Security #) ______UPIN # ______

MCC Behavioral______RR Medicare______

Other______#______Other______#______

Specialty ______

If it becomes necessary to leave web enrollment, please perform a stop and save function. Remember to write down the order number and password you use.

Order # ______

Password ______

Log back in with your vendor URL number

Select the following:

  • I am returning to compete a previously initiated order

Use order number and password to re-enter enrollment process

Until the contract is confirmed at the end of web enrollment, you have not completed the process. Once you confirm the contract, any changes or additions must be made after you receive your user id by completing a provider change form and payer enrollment form obtainable from the ENS website , select download center, select and printout the forms.

Exhibit A ENS Services Pricing

ENS Services / Real Time Transactions Pricing / Commercial Claims Only Pricing / **All Payer Claims Only Pricing / **Claims w/ECT Pricing / **Claims w/Gold Service
Pricing
Standard / Silver / Gold
Subscription Base Price ( 1st Provider or 1st 200 Claims) / $25.00 / $29.00 / $49.00 / $59.00 / $69.00
*Initial Fee - $179
ECT - Electronic Claims Tracking (participating payers) / ***Included / ***Included
Claims Status (participating payers) / Included / ***Included
Eligibility (participating payers) / Included / ***Included
Referrals (participating payers) / Included / ***Included
Authorizations (participating payers) / Included
Electronic Remittance Advice (ERA) w/EOB image & print / 1st Provider / $30.00 / $30.00 / $30.00 / $30.00
Per Transaction Pricing Options: / Per Claim
**** Per Electronic Claim - Option #3 Replaces Flat Rate / $0.35
Per Electronic Remittance Advice Claim (ERA) w/EOB / $0.15
Electronic Paper Claims / $0.43 / $0.43 / $0.43 / $0.43 / $0.43
UB92 Electronic Claims (Institutional claims) / $0.35 / $0.35 / $0.35 / $0.35 / $0.35
Electronic Patient Statements / $0.58 / $0.58 / $0.58 / $0.58 / $0.58
- Additional Page / $0.18 / $0.18 / $0.18 / $0.18 / $0.18
- Custom Statement (Add on) / $0.04 / $0.04 / $0.04 / $0.04 / $0.04
Real Time Transactions (Non-participating payers) / $0.35 / $0.35
Minimum monthly fee $29 with per claim price option
Additional providers or claim volumes – Schedule B

* Initial fee - Setup, installation, testing, training, and enrollment fee per site.

** All payer – Includes participating and non-participating (governmental) payers from ENS payer list –

*** Included in “Gold Service” pricing

****Exclusive with ENS for all payer claims (participating and non-participating payers).

Electronic remittance/Imaging&printing of EOBs is optional service (Internet connection required)

Requires a separate web enrollment on secure ENS website at

Requires a user id which is obtained after enrolling for ENS claim services

Choice between NSF or ANSI 835 files

All electronic remittances are converted to a single format for posting into accounts receivable program

Allows instant access and printing of EOBs online

Choice between flat rate per provider (Schedule B) or per line item on electronic remittance.

Real time transactions are optional services: (Internet connection required)

Services consist of electronic claims tracking (ECT), eligibility, referrals/authorizations, and claim status

These services are referenced by ENS as “gold services”

May be priced separately or included with “gold services” (Exhibit A / Schedule B)

May require payer enrollment

Optional UB92 Institutional Claims:

Requires a separate web enrollment on secure ENS website at

UB92 claims are priced only on a per claim basis or by claim volume

Optional Patient Statements:

Requires additional paperwork obtainable at ENS website under “download center”

Select “Patient Statement Setup Sheet” for submission using file server product WinHecet (print image)

Select “IXT Patient Statement Enrollment Form” to utilize the web based product for file upload

Requires a postage deposit based upon the number of monthly patient statements times current cost of $0.58