National Payers

Please follow the Enrollment Instructions below to become an electronic submitter for CDPHP.

Required Documents for those applying for new Submitter IDs

The following documents are required enrollment documents that must be completed, signed, and returned to the ACS office prior to initiation of electronic claims submission or inquiry.

1. 837 Entity Information Request Form
2. 835 Electronic Remittance Advice Enrollment Request

If you have any questions regarding any of the documents in this package, please call the CDPHP EDI Technology Support Center at 1-518-641-3000

We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.

Our Vendor Information

837 Entity Information Request Form

Header

• Enter your CDPHP Provider number
• Leave the next line blank

Section 1

• Enter your Business Name, Tax ID, and the address your Paper Remits go to

Section 2

• Enter the contact information for the main Business Contact in your office

Section 3

• Enter your Technical Contact information, if other than the Business Contact you entered above
• Sign and date the application

835 Access Request Form

Fill out this form after receipt of your CDPHP User ID

• Enter the date and select "New Enrollment"

Section 1

• Enter your Business Name, NPI, and Tax ID
• Enter the Current Paper Remit Address

Section 2

• Enter the contact information for the main Business Contact in your office

Section 3

• Enter your Technical Contact information, if other than the Business Contact you entered above
• Fill in the next section only if authorizing a third party such as a billing service to receive your remits
• Sign and date the application

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records.

FAX to (518) 641-3301.

It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt. (Remember that mailing time can take as much as five days.)

After processing, a confirmation will be faxed to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the Technology Support Center at 1-518-641-3000.

Testing

Once you have received your Submitter ID and password from CDPHP, please call the SolAce Support Team and set an appointment for a Mailbox setup and Test Transmission to CDPHP

Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.