Guides
Payer enrollment
Track the paperwork some payers need before they take a provider's claims or send ERAs and EFT; the method each payer uses, the statuses and how they move, and the warning a claim gets while enrollment is not active.
Some payers take a provider's electronic claims, or send their remittances (ERAs) and payments (EFT), only once the provider is enrolled with them. The payer directory says which payers need it and how. An enrollment tracks that paperwork for one provider, one payer and one type: claims, era, era_eft. Claim House stores and generates no forms: the method says who does what, and you keep the status and dates current.
The method#
When you start an enrollment, its method is the payer directory's enrollment code for the type at that moment (ERA with EFT takes the ERA code). A payer that needs no enrollment for the type starts the enrollment active.
| method.code | Label | What has to be done |
|---|---|---|
S | Claim House facilitates | Claim House can handle enrollment with the payer. The provider requests it by completing the Claim House enrollment request form and supplying the demographic details asked for, including tax ID and NPIs. |
O | Provider designates Claim House in the payer portal | The payer requires the provider to name Claim House as their billing agent or clearinghouse in the payer's online portal. The provider tells Claim House once that is done. |
W | Payer paperwork (fax or email) | The payer requires its own enrollment paperwork. Claim House supplies a copy, and the provider returns it by fax, email or mail so Claim House can submit it to the payer. |
F | Original paperwork by mail | The payer requires an original copy of its enrollment paperwork. Claim House supplies a copy, and the provider mails the original back for submission to the payer. |
I | Provider completes with the payer | Claim House can start enrollment with the payer, but the provider has to work directly with the payer to finish it, then tell Claim House once it is done. |
U | Enrollment required | The payer requires enrollment, and the listing does not say how it is done. Ask Claim House for the steps. |
| (none) | None required | This payer needs no enrollment for this. It is active from the start. |
A code can carry * (the paperwork is the same form used for claims enrollment) or L (a letter of authorization on the office's letterhead is also needed).
Start one#
POST /enrollments takes the provider, the payer and the type, and optionally sent_on, expected_on and a note. For your office's own notes about the paperwork. Never patient information. One enrollment exists per provider, payer and type in an organization and mode: starting it again answers 409.
curl "https://sandbox.myclaimhouse.com/api/v1/providers" \
-H "Authorization: Bearer $CLAIMHOUSE_KEY" \
-H "Idempotency-Key: $(uuidgen)" \
-H "Content-Type: application/json" \
-d '{"first_name": "Jordan", "last_name": "Example", "credential": "DMD", "npi": "1999990041"}'curl "https://sandbox.myclaimhouse.com/api/v1/payers?supports=claims&enrollment_required=true&limit=1" -H "Authorization: Bearer $CLAIMHOUSE_KEY"curl "https://sandbox.myclaimhouse.com/api/v1/enrollments" \
-H "Authorization: Bearer $CLAIMHOUSE_KEY" \
-H "Idempotency-Key: $(uuidgen)" \
-H "Content-Type: application/json" \
-d "{\"provider_id\": \"$PROVIDER_ID\", \"payer_id\": \"$ENROLLING_PAYER\", \"type\": \"claims\"}"The answer gives the method (its code, label and instructions), the status and the next_step in plain words.
Statuses#
| status | What it means | Can move to |
|---|---|---|
not_started | Not started | awaiting_signature, provider_action, submitted, active |
awaiting_signature | Awaiting provider signature | not_started, provider_action, submitted, active |
provider_action | Waiting on the provider | not_started, awaiting_signature, submitted, active |
submitted | Submitted to payer | awaiting_signature, provider_action, active |
active | Active | not_started |
PATCH /enrollments/{id} changes the status, the dates (null clears one) and the note. A status change outside the table answers 422 on status, saying where it can move. Every change is on your organization's audit trail, with the status it moved from and to.
curl -X PATCH "https://sandbox.myclaimhouse.com/api/v1/enrollments/$ENROLLMENT_ID" \
-H "Authorization: Bearer $CLAIMHOUSE_KEY" \
-H "Idempotency-Key: $(uuidgen)" \
-H "Content-Type: application/json" \
-d '{"status": "active", "sent_on": "2026-09-22", "note": "Confirmed by the payer."}'GET /enrollments lists them newest first, filtered by provider_id, payer_id, type or status; GET /enrollments/{id} reads one.
curl "https://sandbox.myclaimhouse.com/api/v1/enrollments?provider_id=$PROVIDER_ID" -H "Authorization: Bearer $CLAIMHOUSE_KEY"Claims while enrollment is not active#
A claim to a payer that needs claims enrollment, for a rendering provider with no active claims enrollment with that payer, gets the ENROLLMENT_NOT_ACTIVE warning when it is validated: "This payer needs the provider to be enrolled for claims, and the provider has no active claims enrollment with it. Track it on Enrollment; the claim can still be sent." It is a warning only and never stops the claim: the directory's codes can be out of date, and a provider may be enrolled already without it being tracked here. An enrollment started when the payer needed none (active, with no method) counts as none once the directory says the payer needs one: start it over to track the paperwork. Claims validated before this warning existed carry it under the same code.
Who can do what#
Every member of your organization reads its enrollments; owners, admins and developers start and change them. A key with read reads them, and a key with submit also starts and changes them, in its own mode. Resetting your test data deletes your test-mode enrollments.