Enrollment Status

The progress toward enrollment for a Provider within an Organization is a sliced by Payer Groups, States and Lines of Business. Bridge provides a report in the dashboard, and an API/Event integration to be notified of change. Not all payer groups or business lines are available in all Organizations.

Enrollment status is for operational tracking/monitoring, it is not a substitute for eligibility checks. Always refer to the collection of providers returned from Hard Eligibility checks to determine patient eligibility.

Dashboard Reports

Self-serve reports for Provider Credentialing and Eligibility are available in the Reports section of the Bridge Dashboard. These can be used to monitor the progress of initial provider onboarding, through to enrollment across eligible Payer Groups. The report can be exported to CSV.

Provider Enrollment Status API

The API provides a full breakdown of enrollment status and milestone dates by Payer Group, state, and line of business. See the Get EnrollmentStatus API for response format.

When these values are updated, a provider.enrollment_status.updated Event will be generated, and may be delivered by Webhook. This event does not contain detail of the change, your workflow should query for the latest EnrollmentStatus by API and evaluate as necessary.

Within each breakdown, a high level status and several dates are reported. Note, all enrollment submission is predicated on successful initial credentialing. Enrollments are only reported in states the provider is eligible to deliver care, based on licensure.

Possible status values are:

PENDING - The enrollment application has not yet been submitted
SUBMITTED - Application submitted, awaiting processing or appeals
APPROVED - Application was approved, and is pending a future effective date
ACTIVE - Enrollment was approved, and is currently effective
DENIED - Application was denied, and cannot be reattempted
NOT_APPLICABLE - This enrollment is not applicable

Payer Groups

These represent collections of Payer’s that a Provider may be eligible with, when querying/reporting enrollments.

It’s important to know these are not a direct 1-1 mapping to a Payer resource, and they should not be used in place of those for eligibilty checks.

Bridge references Payer Groups by slugs. The slugs are permanent values, but, not all of them are visible to every Organization.

Slug	Name	Usage
aetna	Aetna	Medical and Behavioral Health
bcbs	Blue Cross Blue Shield	Medical and Behavioral Health
evernorth	Evernorth	Behavioral Health
optum	Optum	Behavioral Health
sana	Sana Benefits	Medical and Behavioral Health
uhc	UnitedHealthcare	Medical

Testing

At the time of writing, these events, reports and API’s are unavailable in the sandbox.