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Glossary for Electronic Remittance Advice Enrollment

The glossary below provides details about the fields included in our online Electronic Remittance Advice Enrollment form.

PROVIDER INFORMATION

Provider Name

Complete legal name of institution, corporate entity, practice or individual provider

Provider Address: Street

The number and street name where a person or organization can be found

City

City associated with provider address field

State/Province

ISO 3166-2 Two Character Code associated with the State/Province/Region of the applicable Country

ZIP Code/Postal Code

System of postal-zone codes (zip stands for “zone improvement plan”) introduced in the U.S. in 1963 to improve mail delivery and exploit electronic reading and sorting capabilities

PROVIDER IDENTIFIERS INFORMATION

Provider Federal Tax Identification Number (TIN) or Employer Identification Number (EIN)

A Federal Tax Identification Number, also known as an Employer Identification Number (EIN), is used to identify a business entity

National Provider Identifier (NPI)

A Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered healthcare providers. Covered healthcare providers and all health plans and healthcare clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions

Assigning Authority

Organization that issues and assigns the additional identifier requested on the form, e.g., Medicare, Medicaid

PROVIDER CONTACT INFORMATION

Provider Contact Name

Name of a contact in provider office for handling ERA issues

Telephone Number

Associated with contact person

Email Address

An electronic mail address at which the health plan might contact the provider

ELECTRONIC REMITTANCE ADVICE INFORMATION

Preference for Aggregation of Remittance Data (e.g., Account Number Linkage to Provider Identifier)

Provider preference for grouping (bulking) claim payment remittance advice – must match preference for EFT payment

Method of Retrieval

The method in which the provider will receive the ERA from the health plan (e.g., download from health plan website, clearinghouse, etc.)

ELECTRONIC REMITTANCE ADVICE CLEARINGHOUSE INFORMATION

Clearinghouse Name

Official name of the provider's clearinghouse

Clearinghouse Contact Name

Name of a contact in clearinghouse office for handling ERA issues

Telephone Number

Telephone number of contact

Email Address

An electronic mail address at which the health plan might contact the provider's clearinghouse

ELECTRONIC REMITTANCE ADVICE VENDOR INFORMATION

Vendor Name

Official name of the provider's vendor

Vendor Contact Name

Name of a contact in vendor office for handling ERA issues

Telephone Number

Telephone number of contact

Email Address

An electronic mail address at which the health plan might contact the provider's vendor

SUBMISSION INFORMATION

Authorized Signature

The signature of an individual authorized by the provider or its agent to initiate, modify or terminate an enrollment. May be used with electronic and paper-based manual enrollment

Submission Date

The date on which the enrollment is submitted