The following document is a required enrollment form that must be completed, signed and returned to the MCC of VA office prior to initiation of electronic claims submission or inquiry.

1.https://mccofva.com/media/1531/ebusiness-submitter-profile-form-fill_mccva.pdf

If the link above does not work properly, please download it from here:

Please follow the enrollment instructions below to become an electronic submitter to West Virginia Medicaid.

Please Note: Our connection to WV Medicaid cannot be scripted due to their EDI system’s website structure therefore, once your EDI file has been generated, you will need to upload and download your files manually. We will be glad to walk you through this process.

Users who wish to submit direct to WV Medicaid must sign up for the WV Portal by following the instructions in this document:

Please follow the Enrollment Instructions below to become an electronic submitter to South Dakota Medicaid.

 

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

Utah Medicaid claims must be submitted directly to the Utah Health Information Network.

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

The following documents are required enrollment documents that must be completed, signed and returned to the DHSoffice prior to initiation of electronic claims submission or inquiry.

Billing Agents Only:

  1. MHCP Clearinghouse or Billing Intermediary Enrollment Form
  2. Update Form for Clearinghouses and Billing Intermediaries
  3. Electronic Remittance Advice Request Form

To obtain the forms above, please download them from:

Please follow the Enrollment Instructions below to become an electronic submitter for Disctrict of Columbia Medicaid.

Required Documents

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.

Enrollment Instructions

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

Required Process for those applying for new Submitter ID’s

Online Trading Partner Registration https://www.idmedicaid.com/TradingPartnerRegistration.aspx If you are interested in submitting claims electronically to ID Medicaid, they require you fill out a 5 step online registration form, which we provide the link for above.

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

Required Documents for those applying for new Submitter IDs

The following online application must be completed and submitted to the Medicaid office prior to initiation of electronic claims submission or inquiry.

1. Electronic Data Interchange Trading Partner Agreement

To access the application, please click the following link:

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.

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