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 VT Medicaid office prior to initiation of electronic claims submission or inquiry. 1. EDI Registration Form 2. Trading Partner Agreement If the links listed above do not work properly, please download them from: http://www.vtmedicaid.com/Downloads/tools.html

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI). To apply for a submitter ID and password for OMAP please go to: http://www.dpw.state.pa.us/provider/promise/certification/certificationinfoforansix21v5010ncpdpinteractived.0orbatch1.2/index.htm
  • Scroll Down to the very bottom and click on the link that says: “PROMISe Transaction Certification Registration Form”.
If you have any questions regarding any of the documents in this package, please Call the OMAP EDI Technology Support Center at 1-800-248-2152.

Required Information

We recommend that you have the following information ready before filling out your 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 ACS office prior to initiation of electronic claims submission or inquiry. 1. 837 Entity Information Request Form 2. 835 Access Request Form 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

Enrollment Instructions

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

Required Process for those applying for new Submitter IDs

To Enroll in Alabama Medicaid's Electronic Data Interchange system please call the SolAce Support Team at 602-439-2525. We will contact Alabama Medicaid for you and sign you up for a Trading Partner ID, User ID and Password, so that you may send your claims Electronically via SolAce.

Testing

Once we have received your Submitter ID and Password from AL Medicaid, we will set an appointment with you for a Mailbox setup and Test Transmission to AL 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 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 Documents for those applying for new Submitter IDs

The following documents are required enrollment documents that must be completed, signed, and returned to the Medicaid office prior to initiation of electronic claims submission or inquiry. 1. Trading Partner Agreement Enrollment Instructions for Providers http://www1.scdhhs.gov/openpublic/hipaa/webfiles/TPE%2010-2011%20Providers%20ONLY.pdf If you have any questions regarding any of the documents in this package, please phone the Medicaid EDI Technology Support Center at 1-888-289-0709 option 2.

Required Information

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/Process

To become a direct submitter to the Tufts B2B Gateway system, please send an email to edi_operations@tufts-health.com. In the body of your message let them know you would like to begin submitting 837 files directly to the Tufts B2B Gateway system. Please include your Tufts ID, Tax ID and NPI as well as your Organization's name in your email.

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 NGS office prior to initiation of electronic claims submission or inquiry. 1. EDI Enrollment Form 2. EDI Submitter Action Request Form 3. EDI Third Party Form

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 Medicaid office prior to initiation of electronic claims submission or inquiry. 1. Trading Partner Agreement (not available in PDF, you must download the Word Format.) (Click on “Word Format” next to Trading Partner Agreement)

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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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I am a new client and was having a tough time getting everything set up just right. I had to make calls to CEDI and when I called back the rep I spoke with prior even helped the 2nd rep to make sure I got all the info I needed. They definitely work as a team. Within a short period of time they had my system up and running. I never could've done it without them.

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