What is the timeframe for payer enrollment to get approved?

Purpose:

To provide providers with realistic expectations for payer enrollment processing times and highlight critical considerations for claim submission during enrollment periods.

Scope:

This article covers:

1. Variable processing times across payers
2. Medicare's standard 45-day timeline
3. Claim submission restrictions during enrollment 
   Excludes:
4. Payer-specific enrollment procedures
5. Retroactive claim adjustments
6. Enrollment status troubleshooting

Procedure:

1. Review Payer Timelines:
   1. Medicare: 45 days standard processing
   2. Other payers: 2 weeks to 2+ months (refer to internal timeline table)
2. Submission Guidelines:
   1. Do not submit electronic claims for DOS prior to enrollment approval
   2. Monitor payer-specific enrollment portals for updates

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This depends on the payer; Medicare usually takes 45 days

Some payers require providers to enroll with them before the provider can submit electronic claims and/or receive electronic payment reports (ERAs). Processing time for these enrollments varies by payer and can take anywhere from 2 weeks to over 2 months. The table below contains estimates (in weeks) for how long you can expect to wait for an enrollment to be accepted. 

How long an enrollment takes to process is ultimately up to the payer.

Important: Some payers will reject claims submitted electronically if the date(s) of service on the claim took place prior to a claim filing enrollment being accepted.