ERA and EFT Instructions
EFT Enrollment Instructions
** EFT Enrollment "only" will not be accepted. EFT Enrollment must include ERA Enrollment. **
** ERA and EFT DEG 1 through DEG 4 data must match. Our system will store one set of date. **
Provider Information (DEG 1)
Provider Name, Street, City, State, ZIP Code are all required fields.
Provider Identifiers Information (DEG 2)
Provider TIN and NPI are required fields. If you are an Atypical Provider, NPI field will be blank.
The TIN and NPI provided in DEG 2, must be the TIN or NPI used in DEG 7.
** Changes from TIN to NPI or NPI to TIN will require a cancellation to current version and an enrollment to new version. **
Assigning Authority and Trading Partner ID is only required if your Method of Retrieval is through Utah Health Information Network (UHIN). Please provide your UHIN ID (HT#).
Provider Contact Information (DEG 3)
Provider Contact Name, Telephone Number, and Email Address are all required fields.
Provider Agent Information (DEG 4)
No required data fields. However, if entering a Provider Agent Name, then Contact Name, Telephone Number, and Email Address will be required.
Financial Institution Information (DEG 7)
Financial Institution Name, Routing #, Type of Account, and Bank Account are required. The TIN and NPI provided in DEG 2, will be displayed in the Account Number Linkage to Provider Identifier section, enrollee will need to select one or the other. The selection of TIN or NPI must match the TIN or NPI selected in the ERA Enrollment. This information will be used to identify your ERA Method of Retrieval and bank account information.
** Contact your financial institution to arrange for the delivery of the CORE-required Minimum CCD+ Data Elements necessary for successful reassociation of the EFT payment with the ERA remittance advice as referenced in CAQH CORE 370 Rule. **
Submission Information (DEG 8)
Reason for Submission will be determined by the Enrollment link chosen (New, Change, Cancel).
Enrollee will have the opportunity to read and agree to the Authorization language. Authorization must be agreed to, to complete EFT enrollment.
Enrollee will have the opportunity to type the name of the person submitting the enrollment.
Current date will display in Submission Date.
"Cancel" button will delete all data Enrollee added or change, and return enrollee to the secured enrollment page.
"Submit" button will validate all require data has been entered before displaying completion confirmation to enrollee.
ERA Enrollment Instructions
** DEG 1 through DEG 4 data must match, our system will store one set of data. **
Provider Information (DEG 1)
Provider Name, Street, City, State, ZIP Code are all required fields.
Provider Identifiers Information (DEG 2)
Provider TIN and NPI are required fields. If you are an Atypical Provider, NPI field will be blank.
The TIN and NPI entered in DEG 2, must be the TIN or NPI used in DEG 7.
** Changes from TIN to NPI or NPI to TIN will require a cancellation to current version and an enrollment to new version. **
Assigning Authority and Trading Partner ID is only required if your Method of Retrieval is through Utah Health Information Network (UHIN). Please provide your UHIN ID (HT#).
Provider Contact Information (DEG 3)
Provider Contact Name, Telephone Number, and Email Address are all required fields.
Provider Agent Information (DEG 4)
No required data fields. However, if you enter a Provider Agent Name, then Contact Name, Telephone Number, and Email Address will be required.
Electronic Remittance Advice Information (DEG 7)
The TIN and NPI provided in DEG 2 will display in the Preference for Aggregation of Remittance Data. Enrollee will need to select one or the other. The TIN or NPI selected must match what is submitted in the bill. We will use the TIN or NPI from the bill to locate your "Method of Retrieval".
** Changes from TIN to NPI or NPI to TIN, will require a cancellation to current version, and an enrollment to new version. **
Method of Retrieval
- Emdeon – Provider must have established a connection at Emdeon for State Farm – Health's Emdeon Payer ID 31053.
- PNC Bank – Provider must have established a connection at PNC Bank to receive ERA's from State Farm – Health.
- UHIN – Provider or provider's clearinghouse must be a member of UHIN and have UHIN Trading partner # (HT#). State Farm – Health's UHIN Trading Partner number is HT005054-001.
- CORE Connectivity – Safe Harbor – This method supports the Phase II CORE 270 Connectivity Rule Version 2.2.0. Selecting the method will require you to agree to the Safe Harbor Terms of Use. This method will require additional days to setup to allow State Farm to provide you with credentials. When retrieving your files, your Sender/Receiver ID (depending on the CORE transaction being exchanged) will be either your TIN or your NPI, whichever you selected as your Preference for Aggregation. State Farm's Sender/Receiver ID is SFCORE.
Electronic Remittance Advice Clearinghouse Information (DEG 8)
No required data fields.
Electronic Remittance Advice Vendor Information (DEG 9)
No required data fields.
Submission Information (DEG 10)
Reason for Submission will be determined by the Enrollment link chosen (New, Change, Cancel).
Enrollee will have the opportunity to read the Authorization language and agree to the language. Choosing to decline the Authorization language, will prevent enrollment from completing.
Enrollee will have the opportunity to type the name of the person submitting the enrollment.
Submission Date will be prepopulated with current date.
"Cancel" button will delete all data Enrollee added or change, and return enrollee to the secured enrollment page.
"Submit" button will validate all require data has been entered before displaying completion confirmation to enrollee.