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 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)

Enrollment Instructions

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

Enrollment Procedures:

Applicants must first enroll for an EMOMED account at www.emomed.com Please follow the instructions below on how to apply for your Emomed account:
  • Open your Internet browser and go to www.emomed.com
  • On the right, in the Login box, click on Register Now
  • Press Continue
  • Click I Agree on the Agreement
  • Enter the characters as seen
  • Select your biller type
  • Complete the rest of the form with your information, see notes below

Enrollment Instructions

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

To Apply for a Submitter ID:

  • To apply, providers must call 573-751-7432 and press option 2 to speak to a tech.
  • Ask for Hope Berhorst and tell her that you are interested in Batching into CIMOR via FTP.
  • At that time she will give your Test site address and log in ID.

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 Process for those applying for new Submitter IDs

The following procedure has been established for electronic HIPAA Claims submission: (Link for instructions: http://dhmh.maryland.gov/hipaa/SitePages/testinstruct.aspx ) A provider who would like to submit claims electronically must successfully complete two phases of testing. 1. Phase One testing is through the EDIFECS Commerce Desk. 2. Phase Two testing is through the Maryland Medicaid Electronic Exchange (MMEE) Portal. This phase will be processed through the MMIS-II test region. Phase 1 - EDIFECS Commerce Desk New applicants must submit an e-mail to HIPAAEDITEST@DHMH.STATE.MD.US

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI). To apply for an electronic Submitter ID and Password for TX Medicaid’s billing system please call 888-863-3638 and ask for the EDI helpdesk. Once you have a representative on the phone please give them your Provider number and ask if they can set you up for electronic billing. They should assign you a user name and password. They will also ask for your software vendor information, which is provided in the table below.

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

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 tot he Wisconsin Medicaid office prior to initiation of electronic claims submission or inquiry. 1. Trading Partner Profile (Submit Online) Click on Trading Partner Profile then click on Submit Online If you have any questions regarding any of the documents in this package, please call the Wisconsin Medicaid EDI Technology Support Center at 1-866-416-4979.

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. IHP Trading Partner Profile (must be completed online) 2. IHP Trading Partner Agreement (must be printed and mailed in) If the above links do not work properly, please download the forms 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 MassHealth office prior to initiation of electronic claims submission or inquiry. 1. Trading Partner Agreement If you have difficulty accessing the link above, please go here to download the form: http://www.mass.gov/eohhs/gov/laws-regs/privacy-security/masshealth/edi/masshealth-trading-partner-agreement.html

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 EDS office prior to initiation of electronic claims submission or inquiry. 1. Kansas MMIS Electronic Data Interchange Application If the above link does not work properly, please download the form from: https://www.kmap-state-ks.us/
  • Choose EDI at the top then select EDI Application

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Your Submitter InformationSoftware Vendor Information
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