Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI).

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 Novitas Solutions office prior to initiation of electronic claims submission or inquiry. You may need to copy and paste the links below into your web browser’s address bar in order for them to work properly. 1. Novitas Solutions EDI Enrollment Form (8292) 2. Novitas Solutions Vendor Agreement Form (8291) (For Billing Services Only)

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI).

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 ASK office prior to initiation of electronic claims submission or inquiry. 1. EDI Enrollment Form (New Trading Partner number, 837 Claims) 2. EDI Enrollment Form (Electronic Remittances 835) If the above links do not work properly, please download the forms from here: http://www.ask-edi.com/forms.htm

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI).

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 Lifetime Health care Co office prior to initiation of electronic claims submission or inquiry. Univera 1. Electronic Consent (Trading Partner Agreement) 2. Schedule C Remit Excellus 1. Electronic Consent (Trading Partner Agreement)

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI).

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 Lifetime Healthcare Co office prior to initiation of electronic claims submission or inquiry. Univera 1. Electronic Consent (Trading Partner Agreement) 2. Schedule C Remit Excellus

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI).

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 BCBS office prior to initiation of electronic claims submission or inquiry. 1. Trading Partner Registration Form 2. Trading Partner Agreement (2 copies) If the links above to not work properly please download them from: http://www.bcbsne.com/Providers/Forms/

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI).

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 Palmetto office prior to initiation of electronic claims submission or inquiry. 1. J11 Palmetto GBA EDI Enrollment Packet If the link above does not work properly, please download this packet from the website by going here:

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI).

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 Palmetto office prior to initiation of electronic claims submission or inquiry. 1. J11 Palmetto GBA EDI Enrollment Packet If the link above does not work properly, please download this packet from the website by going here:

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI).

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 Palmetto office prior to initiation of electronic claims submission or inquiry. 1. J11 Palmetto GBA EDI Enrollment Packet If the link above does not work properly, please download this packet from the website by going here:

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

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI).

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 CGS office prior to initiation of electronic claims submission or inquiry. 1. J15 EDI Enrollment Packet In this packet you will be filling out the following forms:
  • EDI Application
  • EDI Enrollment Agreement
  • Online Inquiry Services (DDE for HHH)
  • Provider Authorization Form if using a Billing Service
On the left you will see the forms under "Attachments"

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