Form 3 CAF Application Screenshots

Provider Portal Companion Guide
HRSA COVID-19 Coverage Assistance Fund
Administered by The SSI Group
SSI Phone Support: (833) 967-0770 | TTY: (888) 970-2920
Hours: 8:00 AM to 8:00 PM, EST
Publish Date: May 2021

Table of Contents
Enrollment ........................................................................................................................................................... 3
Figure 1 | Account Creation Form.................................................................................................................................3
Figure 2 | Account Creation Submission......................................................................................................................4
Account Management ......................................................................................................................................... 5
Figure 3 | Account Management...................................................................................................................................5
Figure 4 | Enrollment Pending Status...........................................................................................................................6
Figure 5 | Enrollment Approval......................................................................................................................................6
Figure 6 | Enrollment Denial..........................................................................................................................................7
Bulk TIN/NPI Enrollment Option......................................................................................................................... 8
Figure 7 | Account Management...................................................................................................................................8
Figure 8 | Upload Provider Enrollment File .................................................................................................................8
Submitting a Claim.............................................................................................................................................. 9
Figure 9 | Submitting a Claim........................................................................................................................................9
Figure 10 | Uploading a Claim.......................................................................................................................................9
Figure 11 | Entering a Manual Claim ..........................................................................................................................10
Figure 12 | Completing a Claim Form Manually ........................................................................................................11
Figure 13 | Form Completion.......................................................................................................................................12
Claim Payment .................................................................................................................................................. 13
Figure 14 | Status of Claims ........................................................................................................................................13

Enrollment
To enroll in the program, visit covid19coverageassistance.ssigroup.com/enroll to
start your enrollment. If you are already registered, select “Login Here” at the top
right-hand side of the page to continue. If you have not registered, fill in the
necessary information on the account creation form shown in Figure 1. Please
use Billing Provider details during account creation and any other enrollment on
this site.
PLEASE NOTE...ENROLLMENT MUST BE COMPLETED VIA THIS PORTAL
FOR THE BILLING PROVIDER TIN/NPI. CLAIMS CAN BE SUBMITTED
THROUGH ANY PARTICIPATING CLEARINGHOUSE ONCE ENROLLMENT
IS APPROVED.
Figure 1 | Account Creation Form

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Read and select the “I attest to this statement” box at the bottom of the screen
(Figure 2), then click “Submit.” Your enrollment form is submitted. You will receive an
email confirmation within one business day with next steps, which include your user
ID and instructions to create your login password.
Figure 2 | Account Creation Submission

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Account Management
Once you complete your enrollment and receive an email confirmation, you can
access the Account Management page (Figure 3) to check your enrollment status.
Enrollment validation can take up to four business days, which includes confirming
your tax ID, NPI and banking ACH information. When listed as approved, you will be
able to submit claims through your clearinghouse or on this portal.
Figure 3 | Account Management

As your enrollment processes, the status will show as “Pending,” as shown in Figure
4 below. Enrollment validation can take up to four business days.

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Figure 4 | Enrollment Pending Status

Once approved, your enrollment completion is marked with a green checkmark as
shown in Figure 5, along with your provider PIN which is a unique provider
number assigned to you for this program.
Figure 5 | Enrollment Approval

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If denied, you will see the enrollment denial screen below (Figure 6) with a red “X” and a
message indicating the reason for denial.
Figure 6 | Enrollment Denial

Your enrollment can be denied for numerous reasons, including incorrect banking
information, as shown above, or incorrect/invalid NPI or tax ID. These errors can be
corrected by updating the provider information in the Account Management profile
(Figure 3), as well as by contacting Support at (833) 967-0770.

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Bulk TIN/NPI Enrollment Option

The bulk enrollment option will allow you to upload a CSV file that contains enrollment
data for up to 200 billing providers. Each line will need to include the TIN, NPI, and
Provider Name for the Billing Providers only.
Select “Account Management” and the following screen will appear as shown in Figure 7.
Figure 7 | Account Management

Select “Bulk TIN/NPI Enrollment” and the following screen will appear as shown in Figure 8.

Figure 8 | Upload Provider Enrollment File

Enrollment validation can take up to four business days.
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Submitting a Claim
Please note, while all providers are required to register and receive approval via this
portal prior to claim submission, the two claim submission options described below are
offered only as an alternative for providers that do not have the ability to submit claims
via a participating clearinghouse. There are two options to submit a claim through the
provider portal: 1.) You can upload a claim file into the portal or 2.) You can do Direct
Data Entry and manually enter a new claim. Navigate to the “Claim Status” page shown
in Figure 9. To upload a claim, click on the “Upload Claims” button shown below.
Figure 9 | Submitting a Claim

Upload Claim
Select “Upload Claims” and the following screen will appear as shown in Figure 10.
Figure 10 | Uploading a Claim

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Providers who submit electronically through a clearinghouse can continue to send claims
through their clearinghouse or can upload claims in batches to the portal. If files are
submitted in a valid HIPAA 837 claim format and have a payer ID in the REF02 segment,
your claims will successfully be processed. If you do not have an 837 file, follow the
claim submission instructions below.
New Claim
If you selected “New Claim”, the following screen will appear as shown in Figure 11.
From here, you can select a Professional/CMS1500 claim form for providers submitting
outpatient vaccine administration claims.
Figure 11 | Entering a Manual Claim

Once the appropriate claim type is selected, a template will display into which claim
information can be entered. An example of a professional claim form is displayed on the
following page in Figure 12.

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Figure 12 | Completing a Claim Form Manually
Example of a professional claim form

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Once populated, you can submit the form or save your progress for later completion by
clicking one of the buttons at the bottom of the page (highlighted in Figure 13 below).
Figure 13 | Form Completion

If there are any errors with your claim, the errors will be displayed on the submission
page. Claims status will be shown on the Claims tab in the “Status” column.

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Claim Payment

Once a claim has been submitted and successfully processed, you can expect to receive
an electronic remittance advice (ERA) along with ACH payment in five (5) business days.
If you receive an ERA with a denial of payment, you can correct the claim error and
resubmit.

Figure 14 | Status of Claims

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