Introducing automatic enrollments for failed CMS eligibility checks

When an eligibility check to the Centers for Medicare & Medicaid Services (CMS) fails with AAA error 41 – meaning the provider’s NPI isn’t enrolled with CMS for eligibility transactions – Stedi now automatically submits the required enrollment request. CMS usually processes these enrollments within 24-48 hours.

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

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.