Provider Enrollment, EDI, ERA & EFT Services
Accelerate payer approvals, automate claims and remittance data streams, and fast-track electronic reimbursement deposits directly into your practice bank accounts with Code Credentia's white-glove electronic infrastructure.
Scrubbed against clearinghouse & payer specific rules
Proactive payer follow-ups eliminate idle application lags
Instant bank reconciliation replacing paper check delays
Medicare, Medicaid & top commercial payer networks nationwide
The 4 Foundations of Modern Healthcare Revenue Streams
Code Credentia combines white-glove payer relations with advanced electronic EDI, ERA, and EFT infrastructure. We ensure your providers are enrolled without delay and your reimbursement pipeline flows uninterrupted.
Provider Enrollment Services
Full-cycle payer credentialing and network participation management for solo practitioners, specialty groups, clinics, and hospital systems nationwide.
- Medicare Part A & B enrollment via PECOS and MAC portals
- State-specific Medicaid & Managed Medicaid application submissions
- Commercial payer contracting (BCBS, Aetna, UnitedHealthcare, Cigna, Humana)
- CAQH ProView initial profile setup and quarterly re-attestation
- Type 1 (Individual) & Type 2 (Organizational) NPI registration & maintenance
- Proactive re-credentialing alerts and expiration tracking to prevent lapse
EDI (Electronic Data Interchange)
End-to-end clearinghouse gateway integration and claim stream automation, replacing manual paper claims with sub-second electronic data transfers.
- EDI 837P (Professional) and 837I (Institutional) transaction configuration
- Real-time patient insurance eligibility & benefit checks (EDI 270/271)
- Automated claim status inquiry and response tracking (EDI 276/277)
- Clearinghouse setup & Payer ID mapping (Change Healthcare, Availity, Waystar, Optum)
- Automated batch scrubbing to catch missing modifiers, DX mismatches, and NPI errors
- 277CA clearinghouse acknowledgment review for instant error rectification
ERA (Electronic Remittance Advice)
Automated electronic delivery of detailed claim adjudications, payments, and denials directly into your billing system, completely eliminating paper EOBs.
- HIPAA 835 electronic payment and remittance file enrollment with all payers
- Automated payment and contractual adjustment posting into EHR / PM software
- Instant CARC (Claim Adjustment Reason Code) & RARC denial analysis
- Automated secondary & tertiary claim generation upon primary 835 adjudication
- Detection of payer underpayments, down-coding, and unexpected fee reductions
- Zero manual data entry errors in coinsurance, copay, and deductible balancing
EFT (Electronic Funds Transfer)
Direct, secure bank-to-bank electronic reimbursement deposits that replace slow paper checks, mail delays, and expensive lockbox fees.
- Payer-specific direct deposit ACH enrollment via CMS CMS-588 & payer portals
- Automated 3-way reconciliation matching EFT bank deposit to ERA 835 & original 837 claim
- Reissuance & tracer support for missing or orphaned electronic deposits
- Bank-grade encryption adhering to NACHA rules and federal banking standards
- Elimination of lost checks, paper check processing fees, and bank trips
- Instant reimbursement availability in your accounts within 24 to 48 hours of approval
Why Practices Partner With
Code Credentia
Incomplete enrollment or broken electronic data feeds can stall your cash flow for months. We engineer an airtight revenue bridge so you can deliver exceptional care without financial friction.
Accelerated Cash Velocity
Transition from 30+ day paper check turnaround to 24-48 hour direct EFT deposits, keeping your practice liquid and financially resilient.
Zero Gaps in Reimbursement
Prevent costly billing freezes when onboarding new physicians or opening locations. We initiate and expedite enrollment before providers start seeing patients.
99.8% First-Pass Clean Claims
Pre-clearinghouse rules engines scrub EDI 837 data against specific payer requirements, drastically driving down initial denials and rework.
80% Reduction in Admin Overhead
Eliminate tedious manual EOB paper entry, manual check deposits, and endless phone calls. Automated 835 auto-posting frees up dozens of staff hours.
Comprehensive 50-State Payer Reach
Full coverage across Medicare MACs, state Medicaid agencies, and regional/national commercial insurers including BCBS, Aetna, Cigna, and UnitedHealthcare.
Dedicated Payer Specialists
Never spend 4+ hours on hold with insurance provider relations. Our seasoned credentialing coordinators actively advocate on your behalf with every payer.
Our 5-Stage Electronic Integration Process
From initial discovery through live claim submissions and automated bank deposits, our structured methodology eliminates guesswork and shortens onboarding cycles.
Discovery & Payer Matrix Audit
Days 1 - 3We assess your practice taxonomy, active provider NPIs, geographic service areas, and current payer agreements to map out missing enrollments, inactive clearinghouse connections, and fee schedule opportunities.
Application Preparation & CAQH Optimization
Days 4 - 10Our credentialing specialists compile primary-source documentation, update or build CAQH ProView profiles, resolve attestations, and assemble compliant application packets for Medicare (PECOS), Medicaid, and commercial plans.
EDI, ERA & EFT Electronic Gateway Setup
Days 11 - 20Simultaneously, we configure your clearinghouse EDI connection (837 claim stream), link electronic remittance advice (835 ERA feeds) to your billing software, and submit secure ACH bank authorization forms (CMS-588 & commercial EFT portals).
Test Batch Scrubbing & Validation
Days 21 - 28Before going fully live, we run end-to-end sandbox and test batches through the clearinghouse to verify eligibility queries (270/271), claim receipt, 835 electronic auto-posting precision, and test ACH deposits.
Live Go-Live & Ongoing Lifecycle Management
ContinuousYour practice transitions to fully automated electronic billing and rapid deposits. We provide proactive re-attestation alerts, contract renewals, and dedicated account support so your revenue cycle stays uninterrupted.
In-House Burden vs. Code Credentia Automation
See how outsourcing your provider enrollment and EDI, ERA, and EFT electronic operations eliminates administrative overhead, prevents billing stalls, and dramatically accelerates practice cash flow.
Eliminates 15+ hours/week of manual staff holds and repetitive portal data entry.
Automated ACH electronic funds transfer replacing 3 to 4 week mailed check cycles.
Pre-scrubbed HIPAA 837 data streams preventing front-end rejections and rework.
Traditional Internal Operations
High administrative friction, manual portals, and delayed reimbursement.
90 to 180+ days with frequent delays, missing documents, and unmonitored review cycles
Fragmented payer portals, paper submissions, and high risk of manual typing errors
Manual line-by-line EOB entry taking 20-30 min/claim, creating severe posting backlogs
3 to 4 weeks waiting on paper checks, lockbox processing fees, and physical bank trips
Delayed manual review; secondary claims submitted weeks later or forgotten altogether
Valuable in-house clinical/billing staff spending 15+ hours/week on insurance phone holds
High risk of missed re-attestation deadlines resulting in sudden payer network termination
Disconnected payer tools with zero centralized tracking or real-time claim status transparency
The Electronic Revenue Bridge
Seamless clearinghouse automation, rapid ACH deposits, and continuous protection.
30 to 60 days expedited activation backed by dedicated daily payer advocate tracking
Unified HIPAA 837 clearinghouse gateway with 99.8% first-pass clean claim acceptance
Instant zero-touch 835 electronic remittance auto-posting directly into your EHR/PM system
24 to 48 hours direct ACH deposits credited straight into your practice accounts
Real-time CARC/RARC denial categorization with automated same-day secondary claim generation
Experienced credentialing coordinators manage 100% of payer communications and escalation
Proactive calendar tracking, primary-source verification, and quarterly CAQH ProView protection
Centralized 50-state clearinghouse portal with 24/7 audit trails and automated delivery receipts
Maximize Revenue With AI Audit
Our medical billing and coding team will perform a comprehensive audit of your current RCM processes, identifying missed opportunities and potential areas for growth.
We are committed to helping you provide best-in-class care to your patients while we handle the complicated and time-consuming administrative tasks. Our specialized team handles everything from medical billing to healthcare marketing, ensuring your practice is optimized for maximum efficiency and growth.
Get a Complimentary Financial Audit for Your Practice
Frequently Asked Questions
Everything you need to know about provider enrollment, electronic claim transmission, electronic remittance, and automated bank deposits.
Meet our Customers
We care what our customers think of us and so should you.
We are partners in your business and your success is ours.
Why Code Credentia?
As Healthcare Shifts To Value-Based Care, Traditional Medical Billing And Credentialing Must Evolve. Code Credentia Provides Adaptive Solutions That Ensure Compliance, Maximize Reimbursements, And Support Your Practice In This Changing Landscape.
