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Before you can check a client’s coverage or send a claim, the insurance company has to exist in your practice and your providers have to be enrolled with it. That is what this tab is for. This tab exists only on Solo and Team. It is absent on Enterprise, which runs a different insurance system entirely — so an enterprise colleague genuinely cannot see the screen you are describing to them.

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What this tab controls

Three sub-tabs run along the top. Enrolments cover the transaction types a payer supports — claim status, professional claims, eligibility and remittance — and each one moves through Draft, Stedi Processing, Action Required, Provisioning, then Live, Rejected or Canceled.

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What you need before you start

Gather this once and every later step becomes form-filling. To bill insurance you need, for the practice:
  • Practice name — exactly as registered with payers.
  • NPI — the 10-digit National Provider Identifier (organization NPI for a group, individual NPI for a solo practice).
  • Tax ID — your EIN, or SSN for an unincorporated solo practice. Nine digits, no dashes — enter 111223333, not 111-22-3333.
  • Taxonomy code — your specialty code (e.g. 207Q00000X for family medicine).
  • Billing address — where payers send paper correspondence.
And for each billing provider (the clinician claims are filed under — CMS-1500 Box 33):
  • Their name as payers have it on file, individual NPI (Box 33a) and taxonomy code (Box 33b).
  • A contact person payers can reach about enrolments: first and last name (or an organization name), an email, and a 10-digit US phone number. Enrolments cannot be submitted without these — the form tells you exactly which one is missing.
Check the NPI Registry first. It is the free, authoritative CMS record of every provider — search by name or NPI and it returns the NPI itself, the taxonomy code, and the exact name and practice address as registered. Payers validate against this record, so copy those three from the registry rather than from memory; if the registry itself is out of date (an old address, a maiden name), the provider should correct it at NPPES before enrolling, or the mismatch follows them into every payer’s system.
Mismatches are the main cause of rejected enrolments and claims: the name, NPI and Tax ID you enter must match what the payer’s records hold, character for character.

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Billing profiles — when one identity isn’t enough

Your practice-wide defaults (above) cover a solo practitioner, or a group that bills every claim under the same identity. A group with more than one clinician usually needs more: each clinician’s own individual NPI has to reach Box 24J (the rendering provider) on the claims they personally saw the patient for — not the practice’s Type 2 NPI. That is what Add Billing Profile is for. A billing profile is an override, scoped by up to three things:
  • Clinician — leave as All Clinicians for an override that applies practice-wide, or pick one so it only ever applies to claims rendered by that person.
  • Payer — leave as All Payers, or pick one so the override only applies to claims billed to that specific insurance company (a practice that bills Medicare under a different arrangement than commercial payers uses this).
  • Location — only shown once your practice has more than one site under Settings → Locations. Leave as All Locations, or pick one so the override only applies to visits at that address.
For each profile you also choose:
  • Provider type — Individual (a Type 1 NPI — a specific clinician) or Organization (a Type 2 NPI — a billing entity). A clinician’s own profile is almost always Individual.
  • Use default information from practice settings — turn this on when the profile only needs to say WHO or WHERE it applies to, and should otherwise just use your practice-wide identity. Leave it off to type this profile’s own name, NPI, taxonomy and address.
How a claim picks between them. When you open or prefill a claim, ClinikEHR looks for the most specific match first: a profile scoped to both the claim’s clinician and its payer, then one scoped to just the clinician, then your practice-wide defaults. Nothing is ever invented — if no profile and no practice default has an NPI, the field is left blank for you to fill in rather than guessed at.

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Set it up

1

Fill in your insurance profile

Open Insurance Profile Settings and complete the Practice information card — Practice Name, NPI, Tax ID or SSN, Taxonomy and Billing Address, choosing Individual or Organization to match how you are registered. Then set the Default billing provider (Box 33): the Billing provider name, NPI (Box 33a) and Taxonomy code (Box 33b) printed in box 33 of every CMS-1500 claim. Claims are submitted under this identity, so a wrong value here fails every claim, not one.
2

Give each clinician their own billing profile (group practices)

If more than one clinician sees patients at your practice, select Add Billing Profile for each one: set Target clinician to them, leave Target payer and Target location on All unless they need narrowing, and choose Individual. The NPI field pre-fills, read-only, from that clinician’s own individual NPI (set on their Account Settings) — you do not need to retype it. This is what lets a claim automatically fill in the RIGHT clinician’s NPI in Box 24J instead of leaving it blank or printing the practice’s own. A solo practice can skip this step — the practice-wide defaults already are that one clinician’s identity.
3

Only if this clinic/payer needs a different NPI

Check Use a different NPI for this clinic/payer, then edit the NPI field. If the value you enter differs from the clinician’s own NPI, the page shows a warning and asks you to confirm before saving — this is a deliberate override, not a typo, and the confirmation is required both here and on save.
4

Add your first payer

Go to Payers, select Add Payer › Payer search, and search by name, payer ID or alias. Select the payer and it is added to your practice — a “{Payer} added to your clinic” toast confirms it.
5

Check what that payer supports

Open the row menu and select View Stedi Details. This tells you which transactions the payer supports and whether enrolment is required for each — a payer marked “No enrollment required” for claim filing needs no further work.
6

Register the provider

Move to Provider Enrollment and select Add Provider. The form arrives prefilled from your Insurance Profile Settings — name, NPI, Tax ID and address — so review each value rather than retyping it, then add the contact email and phone, which the profile does not carry. Payers use that contact to reach you about the enrolment.
7

Enrol the provider with each payer

Create an enrolment for the provider and payer, choosing the transaction types you need. Which types need enrolment is the payer’s decision, not ours — check View Stedi Details on the payer: each transaction is marked either “No enrollment required” (works immediately) or “Enrollment required”. Remittance (ERA) almost always requires enrolment even where claims do not — without it, you can file but the payment reports never come back. A new enrolment starts as a Draft.
8

Submit it

Submit the draft. It moves to Stedi Processing and leaves your hands.
9

Clear anything asked of you

A status of Action Required means the payer needs something from you — usually a signed form. Upload it against the task (“Upload PDF”), then use the sync action to refresh the status. Enrolments do not update themselves on a schedule.

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What changes once you save

Adding a payer makes it selectable in two places: when you record a client’s insurance coverage on their chart, and when you create a claim. An inactive payer stays in the list, greyed, and drops out of both pickers — that is how you retire a payer you no longer bill without losing its claim history. Enrolment is the part that actually permits submission. Adding a payer alone does not let you file with it. Until the enrolment for that provider, payer and transaction type reaches Live, claims to that payer will fail — and they fail at submission, not at the point you build them, so the first sign is usually a rejected claim rather than a blocked button. Plan for it: enrolment is a real-world approval process measured in days or weeks, not a save. Removing a payer behaves differently depending on its history. If it has claims against it, the confirmation says so — “This payer has existing claims and will be deactivated (not deleted)” — and it is deactivated so the claim record stays intact. A payer with no claims is removed permanently. Nothing on this tab changes an existing claim. Claims already submitted keep the payer and profile they were filed with.
Eligibility checks and claim submissions are charged per use. What each one costs depends on your plan — see Plans overview. Adding payers and creating enrolments costs nothing; running checks and filing claims does.

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Check it worked

Open any client’s chart and start recording insurance coverage. The payer you added should appear in the picker. Then return to Provider Enrollment — the enrolment you submitted should show a status other than Draft, and the Payers tab’s Total Payers and Active counters should have moved.

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Common issues

Insurance Settings only exists on Solo and Team plans. If your practice is on Enterprise, insurance is handled elsewhere and this tab is deliberately hidden.
It is inactive. Open the row menu on the Payers list and select Activate — only active payers appear in the coverage and claim pickers.
Check the enrolment for that provider and payer under Provider Enrollment. Anything short of Live — especially Action Required — means you are not yet cleared to file with them. Clear the outstanding task, upload the document it asks for, then sync the status.
Statuses do not refresh on their own. Use the sync action on the enrolment to pull the current state. If it genuinely has not moved, Action Required is the status worth re-reading — it usually names a document only you can supply.
That message is the fix, not the failure. Submissions are checked before they leave: a missing contact email or phone, a Tax ID that is not exactly nine digits, or an NPI that is not exactly ten are refused with the field named, instead of coming back from the clearinghouse as an unreadable rejection. Edit the provider’s details, and the draft is kept for you to resubmit.
Payers accept an effective date from today up to six months out. A date outside that window is dropped rather than rejected, and the enrolment takes effect from its submission date — the closest achievable version of your intent.
That is deliberate. A payer with claims against it is deactivated rather than deleted so the claim history stays readable and auditable. Only a payer with no claims is removed outright.
The practice-wide Default billing provider covers Box 33 (who bills), not Box 24J (who actually saw the patient) once more than one clinician works at your practice. Add a Billing Profile for that clinician (Add Billing Profile → Target clinician → Individual → their own NPI) — a claim then fills in their NPI automatically the next time it prefills from an invoice or appointment. Nothing is ever guessed: an unresolved NPI is left blank rather than printed wrong.
This tab sets up the practice’s side. Each client’s coverage is recorded on their own record — by sending them the Insurance Profile intake to fill from their card, typing it in with Add Coverage, or letting Discover search the payer network for them — and verified with an eligibility check before the visit. That flow, and building, submitting and chasing the claims themselves, is covered in Insurance claims.