Introducing automatic enrollment requests for failed CMS eligibility checks

Note: This feature was previously called "CMS automatic enrollment." For more information on the name change, see this changelog entry.

The Centers for Medicare and Medicaid Services (CMS) requires that providers complete transaction enrollment to run eligibility checks through Stedi or other clearinghouses.

When an eligibility check to CMS fails with AAA error 41 – meaning the provider isn’t enrolled with CMS for eligibility transactions – Stedi now automatically submits the required transaction enrollment request.

With this change, Stedi customers no longer need to track down and submit missing enrollments when a Medicare eligibility check fails. Stedi handles that work for you.

This new feature reduces your operational overhead and helps ensure future Medicare checks will succeed.

What is transaction enrollment?

Transaction enrollment is the process of registering a provider to exchange specific healthcare transactions with a payer. CMS – the payer used to check eligibility for Medicare Part A and Part B – is one of the few payers that requires enrollment for eligibility checks.

Every eligibility check to CMS (Payer ID: CMS) must include the provider’s National Provider Identifier (NPI). If that NPI isn’t enrolled, CMS returns AAA error 41 (Authorization/Access Restrictions).

Now, when CMS returns AAA error 41, Stedi automatically creates and submits an enrollment request in the background.

Unlike Electronic Remittance Advice (ERA) enrollments, a provider can enroll with CMS and other payers for eligibility checks through multiple clearinghouses.

How CMS automatic enrollment requests work

Stedi's transaction enrollment requests require a provider record.

If a provider record for the NPI used in the failed eligibility check already exists in your Stedi account, Stedi uses the existing provider record to submit the enrollment request.

If no provider record exists for the NPI, Stedi automatically creates one with:

• A tax identification number (TIN) – a Social Security Number (SSN) or Employer Identification Number (EIN) – of NULL.

• The provider contact name, phone number, and address pulled from the National Plan and Provider Enumeration System (NPPES) NPI registry – CMS's national database of provider NPIs.

• A provider contact email address of enrollments@stedi.com.

• A submitter email of enrollments@stedi.com.

This ensures Stedi can submit the CMS enrollment request immediately without needing any additional information from you.

To complete enrollment, the provider must complete attestation and any other enrollment requirements

How to track enrollment requests

You can monitor the enrollment request’s status using Stedi’s Enrollments API or the Stedi portal. When the enrollment’s status is LIVE, the provider can run eligibility checks with CMS and any state Medicare payers, such as Medicare Texas Part B, listed in the Stedi Payer Network.

In addition to transaction enrollment, providers must complete payer enrollment with CMS to become an active Medicare provider. If the NPI isn’t active in PECOS – the system CMS uses to manage active providers – the transaction enrollment request will be rejected with a REJECTED status. If this happens, we’ll send you links and instructions on how to check the provider’s PECOS status.

Availability and pricing

This feature is already live across all Stedi plans. It works for real-time and batch eligibility checks across all JSON, X12, and SOAP API endpoints as well as the Stedi portal.

There’s nothing to configure and no extra cost for enrollments.

Try it today

If you’re new to Stedi, you can sign up for the free Basic plan in under two minutes. It includes 100 free eligibility checks each month and unlimited transaction enrollments.