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) If the links above do not work properly, please click on the following link: Novitas Solutions Home Page If you have any questions regarding any of the documents in this package, please call the Novitas Solutions EDI Technology Support Center at 1-877-235-8073.

Required Information

We recommend that you have the following information ready before filling out your forms:
Your Submitter InformationSoftware Vendor Information
NameVendor Name - AXIOM Systems, Inc.
AddressContact - EDI Team
Phone and Fax NumbersVendor Code - N/A
E-mail AddressPhone - 602-439-2525
Contact NameFax - 602-439-0808
Provider NPI Numbers for this payerAddress - 241 East 4th Street, Suite 200
Frederick, MD 21701
Organization or Group NPI's for this payerSoftware Name - SolAce EMC
E-mail - Support@SolAce-emc.com

New EDI Submitters

Follow these instructions when filling out forms for a new Submitter ID.

Electronic Data Interchange (EDI) Enrollment Form

Section A: Select your Line of Business and State Section B: Enter the name of the Group, Provider, Or Supplier who is applying for a Submitter ID Section C: Enter your Practice’s demographic information Section D: Enter the Provider’s NPI and PTAN Section E: Do not check the box for PC-Ace Pro 32 For name of Software Vendor , enter Axiom Systems, Inc. Formerly Ivertex
  • If Provider is sending and receiving using SolAce, place check mark next to Provider
  • If a Billing Service is sending/receiving on behalf of the provider check, Billing Service
Check the last box in this section about your 855 form if applicable Section F: Place a check next to Assign this provider a new electronic billing submitter ID
  • Select either One Submitter ID or Separate Submitter ID’s per contract, whichever you prefer.
Section G: Skip this section if you do not have an existing submitter ID Section H: Select the box that says “The new submitter ID being requested in block F of this form” Section I: Skip this section Signature Section: Type your Name and Title, then Sign and Date

Novitas Solutions, Inc. Vendor Agreement (Billing Services Only)

Header: Check Billing Service Section I. Enter your Company’s Name, Demographic info, and Contact information
  • For Name of Software enter SolAce-EMC
  • Skip the first Box
  • Check the second box if you wish to not receive paper mail responses.
Section II. Check the box to Assign a new submitter ID.
  • Select the box that says “I am a Billing Service or Clearinghouse that will be submitting claims directly to Medicare”
  • Name of Vendor: AXIOM Systems, Inc. formerly Ivertex
  • Choose either one submitter ID for all Part B contracts or Separate ID’s per contract
    • You would probably want Separate ID’s per contract.
  • Check the box to assign a new ERA Receiver ID if you will be receiving your Provider’s ERAs.
Section III. Check these boxes:
  • Create ANSI ASC X12N 837 claim files in the following version: Check box for 5010
  • Retrieve ANSI ASC X12N 835 remittance files in the following version: Check box for 5010
  • Provide the following type of connection to Novitas Solutions: Check box for FTP and Dial Up
    • You may also select DDE and PPTN. Ask us about our ClaimShuttle Network Service today so we can get you access to the DDE or PPTN screens that you need to access!
  • Provide services to the following contracts: Check applicable boxes for Part A, and/or Part B
Section IV. Skip this section Signature Section: Print your Name and Title, then Sign and Date this application

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records. Mail the enrollment forms reflecting original signatures to:
Novitas Solutions, Inc. EDI Department P.O. Box 890011 Camp Hill, PA 17089-0011 Or Fax to: 1 (877) 439-5479
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 mailed to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the Novitas Solutions EDI Technology Support Center at 1-877-235-8073

Testing

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

Enrollment Instructions

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

Note: This is for Participating Providers Only

To Enroll for a Submitter ID with GuildNet for direct submission of 837P and/or 837I files through PCS, please email their Provider Relations Department at PCS_ProviderRelations@lighthouseguild.org. In the body of your e-mail let them know you are interested in applying for a Submitter ID so you can send your electronic claims directly to them.

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI). To enroll for a submitter ID with Colorado Access please contact their EDI Operations Team at 720-744-5172 and ask to speak to Jennifer Hutchings. Let her know you are interested in applying for a Submitter ID so you can send your electronic claims directly to them.
  • Give her the following information:
    • You will be a direct submitter
    • You need an SFTP Connection
    • You are NOT using a Clearinghouse
    • You are either sending 837P, Professional and/or 837I, Institutional Claims
    • You are able to receive electronic 835 files (Remittance Advice), when they are capable of sending them.

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 SC BCBS office prior to initiation of electronic claims submission or inquiry. 1. Hospital & Healthcare Professional Trading Partner Agreement 2. EDIG Trading Partner Enrollment Form If the above links do not work properly, please download the forms from 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 GBA office prior to initiation of electronic claims submission or inquiry. 1. J1 Palmetto GBA EDI Enrollment Packet To obtain the enrollment forms, please download them from: Link text If you have any questions regarding any of the documents in this package, please call the Palmetto GBA EDI Technology Support Center at 1-866-749-4301.

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 GBA office prior to initiation of electronic claims submission or inquiry. 1. J1 Palmetto GBA EDI Enrollment Packet To obtain the enrollment forms, please download them from: Link text If you have any questions regarding any of the documents in this package, please call the Palmetto GBA EDI Technology Support Center at 1-866-749-4301.

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
To obtain the forms above, please download them from: http://www.palmettogba.com/Palmetto/Providers.Nsf/files/EDI_Enroll_J11_Pack.pdf/$File/EDI_Enroll_J11_Pack.pdf

Palmetto GBA administers Medicare health insurance for the Centers for Medicare and Medicaid Services (CMS) for Jurisdiction J, which includes the state of Tennessee. If you are a provider located in the state of Tennessee and need to become an electronic submitter for your Medicare A/B claims, please follow the instructions below.

Enrollment Instructions

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

Required Process for those applying for new Submitter IDs

Please go to the following link to complete WPS' online Registration Form https://corp-ws.wpsic.com/apps/wtps-web/unauth/RegistrationLoadAction.do
  • Enter your Business or Provider Name in the Submitter Name field
  • Enter your Demographic & Contact Information
  • For To and From Transmission Method, select WGBBS
  • Check the following boxes:
    • Receive Acknowledgement
    • Receive Remittance (If you would like to receive electronic EOB's)
  • For Vendor Name enter: AXIOM Systems, Inc. (formerly Ivertex)
  • Click Save

Enrollment Instructions

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

Required Documents for those applying for New Submitter ID's

The following documents are required documents that must be completed, signed and returned to the Medicaid office prior to initiation of electronic claims submission or inquiry. 1. Electronic Provider Profile Form http://www.bcbst.com/providers/ecomm/getting_started/profile_provider.pdf 2. Secure File Gateway Transition http://www.bcbst.com/providers/ecomm/bcbst_sfg_transition.pdf 3. BlueCross BlueShield of TN Electronic Vendor Profile (For Billing Agents/Clearinghouses ONLY) http://www.bcbst.com/providers/ecomm/getting_started/profile_billing_agent.pdf

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I think our medical office was one of the first to use SolAce in the mid 1990’s and we are still using it today for all of our electronic billing because it works ! It was simple for our staff to learn and it integrated easily with our accounting/billing program. It has been especially nice to know that the Axiom staff is there when Medicare changes something and they are right on it. They made the 5010 change a simple process plus made educational seminars available to us. Thank you to all the Axiom/ Ivertex professionals who have helped us for the last 15+ years.

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SolAce has been a valuable tool that has been a life saver for my billing service for years. It has allowed me to bill professional and institutional claims with ease. Customer service @ SolAce is top rated in my opinion. The SolAce product is very user friendly and affordable. Thank you SolAce team for a great product.

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