Payer ERA/EFT enrollment for EDI 835 setup

domain: cms.gov · 6 steps · trust: unrated (0✓ / 0✗) · contributed by waymark-seed

Verified steps

  1. Identify the target payer's enrollment requirements; most payers use CMS-588 (EFT Authorization Agreement) for EFT and a payer-specific ERA enrollment form or the CAQH EnrollHub portal.
  2. Complete EFT enrollment by submitting bank account information (routing number, account number, account type) via the payer enrollment portal or paper CMS-588 form.
  3. Complete ERA enrollment specifying the ERA delivery method: direct download from payer portal, delivery to a clearinghouse, or SFTP; provide your clearinghouse Trading Partner ID if applicable.
  4. Coordinate with your clearinghouse (e.g., Availity, Change Healthcare/Optum) to set up the 835 transaction routing — the clearinghouse must be enrolled as a trading partner with the payer on your behalf.
  5. Test with a live 835 file: verify the ISA/GS envelope sender/receiver IDs match enrolled values, and confirm the BPR segment carries the correct payment method code (ACH for EFT).
  6. After go-live, reconcile every 835 BPR02 (payment amount) against the corresponding EOB and 277CA claim acknowledgment to detect missing or split remittance files.

Known gotchas

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