APEX Clearinghouse Enrollment Process (US-only)

In this article: 

• Overview of Enrollment Process
• Claiming Costs (Effective January 2025)
• Requesting APEX Clearinghouse Enrollment
• Ready for Claim Submission
• Current Claiming Functionality
• Zanda Claims FAQs

Overview of Enrollment Process

Enrollment Process

Step 1: Subscribe to Zanda Claims with Apex.

• Go to the Settings > Practice >Subscription > Optional Add-Ons in Zanda.
• Select Insurance Claiming and request Clearinghouse Enrollment
• Agree to the terms and conditions.

Step 2: Enroll with Apex.

• Choose your enrollment type: Individual (Type 1 NPI), Group (Type 2 NPI), or Combination.

  • Type 1 NPI (Individual):

    • For healthcare providers who are individuals and sole proprietors. Eligible for only one NPI.

  • Type 2 NPI (Group):

    • For healthcare providers who are organizations, including physician groups, and corporations where an individual incorporates.
  • Combination Enrollment:
    • Credentialed with some payers as a Type 1 and some as a Type 2. Requires a combination enrollment.

Step 3: Process your enrollments with Apex.

• You’ll receive a welcome packet via email. Return it promptly.
• Apex Enrollment team will guide you through the remaining steps.

Step 4: After Apex enrollment approval.

• A unique Apex ID will be provided.

Claiming Costs (Effective January 2025)

• Enrollment Fee: $50.00

• Per Claim: $0.15

• Per ERA: $0.10

• Per Eligibility Request: Free

Requesting APEX Clearinghouse Enrollment

In this section of the article, we will guide you through the APEX enrollment process. 

1. You need to convert your Zanda account to be able to request the clearinghouse enrollment via the Zanda integration. 
2. When you account is converted, go to the Settings > Practice > Subscription > Optional Add-Ons page,  to the 'Insurance Claiming' section.
   
3. Carefully read the provided information and click the 'Request Clearinghouse Enrollment' button.
   

4. Complete the enrollment information form, including your Business Name, Contact Email, Business Contact Phone and Billing Provider NPI Number, and click 'Next' to proceed. 


5. Read the Zanda Integrated Insurance Claims Service Agreement, check the 'I have read and accepted the Service Agreement' box and click 'Submit'

6. After the enrollment application is submitted, go to the Settings > Practice > Subscription > Optional Add-Ons page and continue to Apex to enroll on their side.

7. Once your enrollment is completed, we will send you a confirmation email. 

8. On the Settings > Practice > Subscription > Optional Add-Ons page, you will see the status of your enrollment and your APEX Vendor ID (it will consist of 3 characters). You can use this Vendor ID when you reach out for assistance to APEX support.  

Ready for Claim Submission

After the registration with APEX is completed, you will be able to submit insurance claims. 

1. When on a claim, there will be a "Submit Claim" button available for enrolled client
   

Current Claiming Functionality

Currently, the Zanda in clearinghouse integration provides the following functionality:

1. Linking invoices to claims for easier payment updates.
2. Viewing the status of claims in Zanda.
3. Printing claims as PDFs.
4. After claim submission, Zanda will automatically handle status updates of claims daily, showing the claim status in the system.
   Alternatively, you will also be able to log into Apex to view your payments and manage further details.

5. The Claims report will include the following data columns:

• Claim No
• Date Created
• Status
• Client
• Insurer
• Practitioner
• Amount
• Invoices
• Note
• Actions

Zanda Claims FAQs:

Do I need to enroll with Apex for Zanda Claims?
Yes, Apex is the required clearinghouse.

What is Apex Enrollment?
It notifies payers of your intent to submit electronic claims (EDIs) and receive ERAs through Apex.

Already enrolled with a payer?
You still need to enroll through Apex for claims to be processed in Zanda. It is possible to use your existing Vendor ID, please email to support@zandahealth.com to request adding your existing Vendor ID to your Zanda account. 

Enrollment duration:
It can take up to 45 business days, depending on the payer.