ERA and EFT enrollment: get paid electronically by every payer

The short answer: the ERA (the X12 835 electronic remittance advice) tells you what a payer paid, adjusted and left for the client on each claim; you enroll for it through your clearinghouse, one payer at a time. The EFT is the deposit itself, an ACH transfer in the HIPAA standard format; you enroll for it with each payer (or its payment vendor) using your bank details, and with Medicare on form CMS-588. A trace number on both ties each deposit to its ERA. Plans can't make you accept virtual credit cards: under CMS guidance, if you ask for standard ACH EFT, the plan has to send it. Enroll before your first claims go out, because each payer takes days to weeks to approve.

ERA, EFT, EOB and virtual cards

Thing	What it is	How you get it
ERA (835)	The electronic explanation of a payment: for each claim, the charge, the allowed amount, the payment, every adjustment with its group and reason code, and the client's share. It can post itself to your billing system.	ERA enrollment with each payer, naming your clearinghouse as the receiver.
EFT	The money, as an ACH deposit in the HIPAA standard format (NACHA CCD+ with an addenda record carrying the trace number).	EFT enrollment with each payer or its payment vendor, with your bank account.
EOB / EOP / provider remittance	The paper or PDF version of the ERA.	What you get by default until the ERA is set up; usually also in the payer's portal.
Virtual credit card	A one-time card number you key into a card terminal, paying a processing fee. Outside the HIPAA EFT standard.	Sent by some payers or their vendors unless you opt out and ask for ACH.

What you need before you start

• Legal name and tax ID exactly as on your IRS letter, and the billing NPI the payer pays (the organization's Type 2 for a group or program; see NPI Type 1 vs Type 2).
• The address on file with the payer and in NPPES. A mismatch is the most common reason an enrollment is rejected.
• A bank letter or voided check for an account in the practice's legal name. Medicare requires the account to be in the enrolled provider's name only.
• Each payer's ID for your practice (a provider number, a Medicare PTAN) and your contract or credentialing approval: most payers enroll only providers they already know.
• Your clearinghouse and its receiver ID, for ERA.
• An authorized signer (owner or officer) and a contact who will watch for approvals.

If credentialing isn't finished, start there: how to get credentialed with insurance.

Enrolling, step by step

1. Decide where your remittances go. A payer sends one provider's ERAs to one receiver. If an outside biller or another clearinghouse already receives them, enrolling elsewhere moves them away from it. Settle who posts payments before you enroll.
2. List every payer you bill, with the payer ID on the client's card and who processes behavioral health (often a different company: see carve-outs). Enroll the company that sends the payment.
3. Enroll for ERA through your clearinghouse, payer by payer. Most clearinghouses submit the forms for you; some payers also want a form signed in their own portal. In Cima, ERA enrollment through our clearinghouse is free and each payer usually approves it in one to three weeks.
4. Enroll for EFT with each payer. Through the payer's provider portal or the payment vendor it names. Some plans use a shared enrollment site, and those change: Anthem plans, for example, moved their EFT enrollment to a new portal in 2021. Use the route on the payer's current website.
5. Watch the first payment. When the first ERA arrives, find the deposit with the same trace number and the same amount. Until you've seen one match, keep checking the portal for paper remittances.
6. Keep an enrollment list: payer, payer ID, ERA status and date, EFT status and date, bank account last four digits, and who submitted it. You'll need it when you change banks, billers or tax IDs.

Medicare and Texas Medicaid

• Medicare EFT: form CMS-588, sent to your Medicare Administrative Contractor with a voided check or bank letter. In Texas that's Novitas Solutions (Jurisdiction H). CMS requires EFT for every provider enrolling or changing enrollment, and the account must bear only the enrolled provider's name.
• Medicare ERA: enroll through the contractor's EDI enrollment, naming your clearinghouse, or retrieve remittances through the contractor's portal.
• New to Medicare: counselors and MFTs can enroll since 2024; see Medicare enrollment for LPCs and LMFTs.
• Texas Medicaid: fee-for-service payments come from TMHP, and each Medicaid managed care plan pays separately, so each needs its own ERA and EFT set-up. See Texas Medicaid credentialing.

Matching deposits to remittances

One deposit often pays dozens of claims, and one ERA can describe several deposits' worth of claims. The link is the reassociation trace number: under the CAQH CORE EFT and ERA Reassociation Rule that HHS adopted, the payer puts the 835's TRN segment in the addenda record of the CCD+ deposit, so the trace number in the ERA (TRN02) matches the one that comes with the money.

• Ask your bank to show the addenda. Many business accounts show only "ACH deposit, Payer name" unless you ask for the addenda record. CMS's reassociation basics walks through what to ask for.
• Expect them close together. The CORE rule expects the ERA and the EFT to be sent within a few days of each other (three, in the rule's terms). If one shows up and the other doesn't within a week, call the payer with the trace number.
• Reconcile weekly: total of ERAs posted = total of deposits received, by payer. A gap is a missing ERA, a payment sent to an old account, or a recoupment taken out of the deposit (see provider-level adjustments below).

Virtual credit cards and fees

Some payers and their payment vendors pay by virtual card by default, and the card processing fee comes out of your payment. CMS's guidance is direct: a health plan can't require a provider to accept virtual card payments; if the provider asks for EFT through the ACH network, the plan must comply; and payment vendors acting for the plan are bound the same way (CMS guidance letter; 2022 FAQs). The same guidance says you don't have to be in network to get standard EFT and ERA.

• Opt out in writing the first time a card arrives, and ask for standard ACH EFT and the ERA.
• Read the vendor's enrollment screen carefully: "premium" or "enhanced" ACH options with a percentage fee are not the standard EFT. Ask for the free standard option.
• If a plan refuses, CMS takes HIPAA transaction complaints; the guidance letters above explain the process.

Posting ERAs without making a mess

Auto-posting saves hours, but only if the rules are right. These are the ones we built into our own engine after watching what goes wrong:

• Post the three amounts separately: the payment, the contractual adjustment (CO, and OA or PI where they apply) and the client's share (PR). Never let a CO amount land on the client.
• Read the claim status, not the amount. A $0 payment can be a denial or a claim that went entirely to the deductible. The 835's claim status code says which.
• Never auto-post a reversal. When a payer takes back a payment (it reprocessed the claim, or paid the wrong provider), flag it for a person, who posts the reversal and the corrected payment together.
• Apply each remittance once. Payers resend files; a second copy must not post twice.
• Hold what doesn't match. A remittance line that doesn't match any claim (wrong claim number, a different practice's NPI) goes to a review list, never onto the closest-looking claim.
• Watch provider-level adjustments. The 835's PLB segment carries interest (including Texas prompt-pay penalties, see the prompt pay guide) and recoupments taken from this payment for an older claim. Post them to the claims they belong to.

Then work what posted as denied: what each denial code means.

Changing clearinghouses or billers

• Pick a cutover date and tell the old biller. Enrolling ERAs with a new clearinghouse ends them at the old one, payer by payer, as each approval comes through.
• Give the old biller read access to the payer portals for the run-out of claims it sent, or agree who posts those payments.
• Don't change bank accounts during the switch. Change one thing at a time so a missing deposit has one possible cause.
• New tax ID or NPI (a sale, a new entity) means new enrollments everywhere. Payments under the old ones can't move to the new account; see buying or selling a treatment center.

When something doesn't arrive

Symptom	Likely cause	What to do
Deposits, but no ERA	EFT is enrolled but ERA isn't, or ERAs still go to a previous clearinghouse or biller.	Check the ERA enrollment status; ask the payer where your 835s are being sent.
ERA, but no deposit	Paid by paper check or virtual card; EFT not enrolled or rejected.	Look up the payment number in the payer portal; finish EFT enrollment; opt out of cards.
Nothing for weeks	Enrollment pending or rejected for a name, address or NPI mismatch.	Get the rejection reason; fix the record at the payer and NPPES first, then resubmit.
Payments under the wrong NPI	Claims billed under a clinician's Type 1 NPI instead of the group's, or the payer has the clinician linked to another group.	Fix the billing NPI on the claims and the clinician's group link with the payer.
Deposit smaller than the ERA's claims	A recoupment or offset in the provider-level adjustments.	Find the PLB line, identify the claim it's taken from, and check the recoupment notice.

ERA in Cima

• Settings → Insurance lists your ERA enrollments by payer with their status, and suggests the payers your active clients have that you haven't enrolled yet. Enrolling is free.
• When a payer's ERAs start, payments, write-offs and client shares post to each claim by themselves, and claims show Paid or Denied with their codes. Reversals and anything that doesn't match are held for a person.
• Each electronic remittance is billed at our clearinghouse's standard price, about 20¢ per claim, with claims about 30¢ (pricing). No percentage of collections.
• If an outside biller already receives your ERAs, Cima warns you before you enroll, because enrolling moves them. See billing and claims.

Once money posts on its own, the next job is following up what didn't: working your AR aging report. Or see Cima Consulting's billing services.

Questions

What is the difference between ERA and EFT?

The ERA (X12 835) is the electronic explanation of what was paid on each claim and why; the EFT is the money itself, deposited by ACH. You enroll for the ERA through your clearinghouse and for the EFT with each payer, and a shared trace number links each deposit to its ERA.

How long does ERA enrollment take?

It depends on the payer. Through Cima's clearinghouse, most approve in one to three weeks; some need an extra signature in their own portal. Enroll as soon as your contract is effective so the first payments arrive electronically.

Do I have to enroll with every insurance company separately?

Yes. ERA and EFT are set up payer by payer, and for each payment source within a payer (Medicaid managed care plans and behavioral health companies each count separately). Some shared portals let you reach several payers at once, but not all payers use them.

Can an insurance company make me accept virtual credit card payments?

No. CMS guidance says a health plan, and any payment vendor acting for it, can't require virtual card payments, and must send standard ACH EFT if you ask for it. Opt out in writing and ask for the standard EFT, not a fee-based "premium" option.

What form do I use for Medicare EFT?

Form CMS-588, sent to your Medicare Administrative Contractor (Novitas Solutions for Texas) with a voided check or bank letter. The account must be in the enrolled provider's name only.

Can two clearinghouses receive my ERAs from the same payer?

Usually not: a payer sends a provider's remittances to one receiver. That's why enrolling with a new clearinghouse ends ERAs at the old one, and why you should agree on who posts payments before you switch.

Sources

• CMS, EFT and ERA reassociation basics; guidance letter on virtual credit cards, EFT and ERA; GL-2022-04 FAQs
• CMS, Form CMS-588, Electronic Funds Transfer authorization agreement
• HHS, Operating rules for EFT and remittance advice; CAQH CORE, EFT and ERA Reassociation (CCD+/835) Rule
• 45 CFR §162.1602, HIPAA standards for health care EFT and remittance advice
• Our clearinghouse integration's enrollment and posting rules (Cima EHR, October 2026)