How payers route ERAs

If a claim is a bill for healthcare services, an Electronic Remittance Advice (ERA) is the receipt.

ERAs – also called remits – explain what the insurer (the payer) paid, what they didn’t pay, and why.

Providers and their billing partners use ERAs to match payments to the original claims and keep their accounting current – a process called reconciliation.

For providers, ERAs are critical for recording accurate payments. But small details, like which provider ID a payer uses to route ERAs, can quietly break workflows.

This guide explains how payers route ERAs, Stedi’s logic for passing them along, and how those choices can impact provider workflows. If you’re building ERA workflows with Stedi, this guide will give you a mental model and tips for handling real-world payer behavior.

ERA enrollment

Transaction enrollment is the process of registering a provider to exchange specific healthcare transactions, like claims or ERAs, with a payer. Transaction enrollment is always required for ERAs.

A payer only sends ERAs to the clearinghouse that the provider has enrolled with. A provider can only enroll with the payer through one clearinghouse at a time. For example, if a provider receives ERAs from Cigna through Stedi, they can’t get those ERAs through another clearinghouse.

For other transaction types, enrollment requirements vary by payer. You can check a payer’s enrollment requirements and expected approval timelines in the Stedi Payer Network or using Stedi’s Payers API.

How Stedi handles enrollment

Stedi offers fully managed transaction enrollment at no extra cost. You can submit enrollment requests using Stedi’s Transaction Enrollment API or the Stedi portal, which supports bulk CSV uploads.

Regardless of whether you use the API or the portal, you follow these steps to submit an enrollment request:

1. Create a provider record with the following information for the billing provider:

   1. Tax identification number (TIN)

   2. National Provider Identifier (NPI)

   3. Contact information

Each provider record must have a unique TIN and NPI combination.

2. Use the provider record to create an enrollment request for a specific transaction type and payer.

Once the enrollment request is submitted, Stedi emails you with status updates, and you can track progress in the API or the portal.

When the payer approves the enrollment, the enrollment status is set to LIVE, and the provider can start exchanging the enrolled transactions – like ERAs – with the payer. For more details, see our Transaction enrollment docs.

Billing providers vs. rendering providers
The billing provider is the entity that will receive payment for claims from the payer. This could be a person, such as a doctor running a solo practice, or an organization, such as a clinic or group practice.

The rendering provider is the person who actually delivered care. The rendering provider may be a different person or entity from the billing provider.

For example, a therapist who is part of a clinic may bill claims using the clinic’s TIN and NPI. The therapist is the rendering provider. The clinic, which has a separate TIN and NPI, is the billing provider.

When submitting enrollment requests with Stedi, you only create a provider record for the billing provider, not the rendering provider. 

TINs
A tax identification number (TIN) is a 9-digit tax ID – either a Social Security Number (SSN) or Employer Identification Number (EIN). 

TINs are sometimes shared across multiple billing providers within the same organization. For example, a multi-location medical group may use a single TIN across all locations, even though each location is listed as a billing provider with its own NPI.

For claims and enrollment requests, you only need to provide the billing provider’s TIN, not the rendering provider’s.

NPIs
An NPI is a 10-digit ID issued by the Centers for Medicare & Medicaid Services (CMS) to all U.S. healthcare providers. There are two NPI types:

• Type 1 for individual persons

• Type 2 for organizations

Regardless of type, an NPI uniquely identifies the provider entity. Unlike TINs, NPIs aren’t shared across multiple provider entities.

Claims often require both the billing provider’s and rendering provider’s NPIs. However, Stedi enrollment requests only use and require the billing provider’s NPI. Don’t include the rendering provider’s NPI in enrollment requests.

How payers route ERAs

A payer only sends ERAs to the clearinghouse that the provider has enrolled with.

Most – but not all – payers determine where to send ERAs based on the billing provider’s TIN – not NPI – in the related claim. Because of this, changing the clearinghouse used to receive ERAs for one billing provider using the TIN may automatically change it for every other billing provider using the same TIN.

Example
A multi-location medical group submits claims for several doctors using a single TIN. When submitting claims, the location is listed as the billing provider with each location using its own NPI. The individual doctor is listed as the rendering provider.

The medical group submits an enrollment request to switch the clearinghouse used to receive ERAs for one location to Stedi. The enrollment request includes the medical group’s TIN and that location’s NPI. 

The payer routes ERAs by TIN. When the payer processes the request, the payer automatically enrolls all other NPIs associated with the medical group’s TIN to receive ERAs through Stedi. That means the medical group’s other locations now receive ERAs through Stedi.

ERAs can only be sent to one clearinghouse at a time. The payer stops delivering ERAs for the medical group’s other locations to their previous clearinghouse. If this change is unexpected, it can disrupt the medical group’s ERA workflows.

Missing TINs
Although it’s commonly included, payers are not required to include the billing provider’s TIN in an ERA, even if the TIN was used to route the ERA. However, the payee NPI – typically the billing provider’s NPI – is required.

If a payer doesn’t route their ERAs by TIN, they route ERAs based on payee NPI instead. In these cases, you can use Stedi’s enrollment records to match the payee NPI to the TIN.

Stedi’s routing logic

After an ERA reaches Stedi, it’s routed to the right Stedi account using the following logic. It works for both TIN-based routing and cases where the ERA doesn’t include a TIN:

1. If an ERA includes a TIN, Stedi matches it to the billing provider’s TIN on the enrollment record.
   Stedi then routes the ERA to the associated Stedi account.
   
   

2. If an ERA doesn’t include a TIN, Stedi matches the payee NPI to the billing provider’s NPI on the enrollment record.
   Stedi then routes the ERA to the associated Stedi account.

How to listen for ERAs
If you’re building ERA workflows with Stedi, you need a way to know when an ERA arrives and how to retrieve it. Stedi supports several options:

• Webhooks and APIs
  If you want to work in JSON, you can set up a Stedi webhook to listen for incoming ERA events, then retrieve the ERA using the ERA Report API endpoint.
  
  

• SFTP
  If you already work with X12, you can download X12 versions of the ERAs from the from-stedi directory using Stedi’s SFTP connection.
  
  

• Stedi portal
  You can also download ERAs from the Stedi portal, where you can view related claims and acknowledgments handled through Stedi.

Tips for handling ERA routing

• Design for TIN-based ERA routing.
  Don’t assume ERAs will only arrive for NPIs you explicitly enrolled. Many payers enroll and route provider ERAs at the TIN level. Your system should not rely solely on NPI for routing ERAs.
  
  

• Communicate with providers early.
  If you manage multiple NPIs under the same TIN, be aware that changing the clearinghouse used to receive ERAs for one NPI may affect all NPIs under that TIN. If you support providers, communicate this upfront. If you’re a provider organization, coordinate internally across teams and systems to avoid disruptions.
  
  

• ERAs typically arrive in 7-20 days.
  A related ERA typically arrives 7-20 business days after claim submission. They’re preceded by a claim acknowledgment from the payer, which typically arrives within 2-7 days. Use these timelines to set expectations with internal teams or external customers.
  
  

• Confirm enrollment before troubleshooting missing ERAs.
  Before investigating missing ERAs, verify that the provider’s ERA enrollment status with the payer is LIVE. If so, use a real-time claim status check to confirm the claim has been adjudicated (fully processed) by the payer. Payers won’t send an ERA until the claim is adjudicated.

Process ERAs with Stedi

ERAs and fully managed transaction enrollment are available on all Stedi plans.

If you’re not yet a customer, sign up for our free Basic plan. You get free ERAs for the first 100 claims paid each month.