|
Home 
EDI forms
EDI formsEDI Support
General:
888-670-0940 option-1
PC-ACE:
888-670-0940 option-2
DDE:
888-670-0940 option-3
Enrollment:
888-670-0940 option-4
HIPAA Testing:
888-670-0940 option-5
EDI forms
Modified: 2/10/2012
A signed EDI enrollment form must be submitted before a provider may begin to submit/receive EDI transactions.
Modified: 2/10/2012
Use this form to update sender/submitter information or when you need to modify a provider to sender/submitter relationship.
Modified: 2/10/2012
All third party agents must have a signed network service agreement on file before they can send or receive Medicare data for the providers they represent [CR 7269]
Modified: 11/1/2011
The electronic data request form is for Medicare providers who want to apply for or revise existing information pertaining to the ERA and/or ECS transactions. It is now interactive -- fill it out online, then print and fax it.
Modified: 9/22/2011
This form must be submitted in order to sign up to submit claims electronically and/or change support vendor information.
