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.
Please follow the Enrollment Instructions below to become an electronic submitter for Hawaii Medicaid Med-QUEST. 
 

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 Hawaii Medicaid office prior to initiation of electronic claims submission or inquiry.
 
 
1.

Enrollment Instructions

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

Special Enrollment Notes:

Submitters must be the billing provider. Billing services may not enroll themselves as submitters. Solo providers = Billing providers Group Practices = Billing provider (*Rendering providers cannot be submitters) NOTE: BEFORE YOU EMAIL US THIS INFORMATION, MAKE SURE YOU HAVE PURCHASED THE SOLACE SOFTWARE FROM AXIOM SYSTEMS, INC OR HAVE TALKED TO SOMEONE FROM THE AXIOM SYSTEMS, INC SALES DEPARTMENT @ 602-439-2525. To enroll for a Submitter ID with EICBO so that you may use your SolAce Hosted account to transmit your claims, please answer the following questions in an email and send it to the SolAce Support Team:

If you are interested in submitting claims electronically to Paramount Healthcare, please call the SolAce Support Team and we will work directly with Paramount to get you set up for electronic claims submission or inquiry.

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 FHSC office prior to initiation of electronic claims submission or inquiry. 1. FH-35 Electronic Transaction Agreement for Service Centers 2. FH-36 Service Center Operational Information 3. FH-37 Service Center Authorization Form for Providers

Enrollment Instructions

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

Required Documents for those applying for new Submitter IDs

The following are required enrollment documents that must be completed, signed, and returned to the ACS office prior to initiation of electronic claims submission or inquiry. Please go to: http://wyequalitycare.acs-inc.com/forms/EDI_Application_080409.pdf Download and complete the following:
  • Equality Care (Wyoming Medicaid) EDI Application
Please follow the instructions carefully to avoid delays in processing the EDI Information. Remember:
  • YOU are the Provider
  • YOU are the Trading Partner

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 UHA office prior to initiation of electronic claims submission or inquiry. 1. UHA Trading Partner Agreement 2. EDI 837P Professional Claim Registration If you are having trouble accessing the forms listed above, please download them from here: http://www.uhahealth.com/providers/claims.asp

Enrollment Instructions

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

Required Process to apply for a new Submitter ID

  • To apply for an electronic Submitter ID with Maine Care please go to https://mainecare.maine.gov/ProviderHomePage.aspx
  • Click Register under the Trading Partner Sign In box and complete the information on their online form. Please read the following notes to avoid unnecessary delays.
  • The name you enter on the first section of step one should only be a first and last name, do NOT enter middle name, initial, or suffix. This must match your electronic signature exactly.
  • On the bottom portion of Step 1, Please Provide your Tax ID and NPI.
  • Leave the Medicaid Provider Number Blank

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI). All providers must first register for Noridian’s Total Onboarding System in order to become an electronic submitter. Guides can be found at http://www.edissweb.com/cgp/forms/onboard.html Once you have established your Total On Boarding Account, please log into your account.
  • On the first page, click the “Manage NPIs” button and choose your billing NPI.
  • Select the transaction types you want to enroll your Billing NPI for:
    • For Professional claims, click “Enroll” for 837P (5010A1)
    • For Institutional claims, click “Enroll” for 837I (5010A1)
    • To receive your EOBs electronically, click “Enroll” for 835 (5010A1)

Enrollment Instructions

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

Required Process for those applying for new Submitter ID's

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 Acknowledgment
    • Receive Remittance (If you would like to receive electronic EOB's)
  • For Vendor Name enter: AXIOM Systems, Inc. (formerly Ivertex)
  • Click Save

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