TRADING PARTNER ID ENROLLMENT
|
|
|
- Cecilia Garrison
- 6 years ago
- Views:
Transcription
1 PROVIDER PORTAL: Trading Partner ID Enrollment If you are a provider or trading partner submitting electronic transactions to Medicaid, you will need to enroll for a trading partner ID. Trading partner IDs will replace the submitter ID (formerly known as the MC ID). Users in the following groups must enroll: Third-party vendors (clearing houses, billing companies, vendors who perform X12 transaction sets, etc.) Medicaid providers who: Would like to use PES after go-live Utilize EDI direct submit Will upload information into the new portal Providers who receive capitated fee information (formerly managed care fees) related to the following programs: Independent Choices PACE (Programs for All-Inclusive Care for the Elderly) CPC (Comprehensive Primary Care) Private Option or Arkansas Works Long-Term Care adjusted service fee claims Net service fee claims Assisted living PCMH (Patient-Centered Medical Home) All PCPs must enroll as a trading partner to see the details of their managed care fees NOTE: Before go-live, this information was sent on your remittance advice. After go-live, this information has been replaced with a summary line that outlines the dollar amount of the capitated fees. You must enroll for a trading partner ID to receive this information. To enroll for a trading partner ID, follow the steps beginning on the next page. ARMEDICAID HEALTHCARE PORTAL : TRADING PARTNER ID ENROLLMENT PAGE 1 OF 9
2 ➊ ➊ Go to the portal landing page. On the left side, you will see the question Would you like to enroll as a Provider or a Trading Partner? Click Trading Partner. ARMEDICAID HEALTHCARE PORTAL : TRADING PARTNER ID ENROLLMENT PAGE 2 OF 9
3 ➋ ➋ Click Enrollment Application. ➌ Carefully read all the information regarding the online trading partner enrollment process. When you are finished, click Continue. ➌ ARMEDICAID HEALTHCARE PORTAL : TRADING PARTNER ID ENROLLMENT PAGE 3 OF 9
4 ➍ ➎ ➍ Fill out all required fields (denoted with a red asterisk) and any additional information you wish to submit. ➎ When you have finished, click Continue. ARMEDICAID HEALTHCARE PORTAL : TRADING PARTNER ID ENROLLMENT PAGE 4 OF 9
5 ➏ ➐ ➏ Check the box for each transaction set that you will be exchanging. Please note that transaction set 820 (Payroll Deducted and Other Group Premium Payment for Insurance Products) will include detailed information on capitated fees and all managed care fees. ➐ Once you have chosen your transaction sets, click Continue. ARMEDICAID HEALTHCARE PORTAL : TRADING PARTNER ID ENROLLMENT PAGE 5 OF 9
6 Check the box beside I Accept to acknowledge that your electronic signature is equivalent to your written signature. Enter your name in the Your Signature field. When you are finished, click Submit. ARMEDICAID HEALTHCARE PORTAL : TRADING PARTNER ID ENROLLMENT PAGE 6 OF 9
7 The summary page shows you all the information you ve entered in the previous steps. If you want to make any changes, click on the category link on the left side of the page. If all information is correct, click Confirm. ARMEDICAID HEALTHCARE PORTAL : TRADING PARTNER ID ENROLLMENT PAGE 7 OF 9
8 12 14 You will receive an with your new trading partner ID number. Click the link at the end of the to complete the enrollment process Clicking the link in your will take you to the confirmation page with information about your trading partner ID and details on upcoming steps. After reading, click Exit. ARMEDICAID HEALTHCARE PORTAL : TRADING PARTNER ID ENROLLMENT PAGE 8 OF 9
9 Please refer to the Registering on the Portal Provider Job Aid for more detailed information on how to register for the portal. Additionally, if you upload or download files as a billing company, vendor or clearing house, you will need to register on the portal as a trading partner. For detailed instructions on how to complete this process, please see the Registering on the Portal Trading Partner Job Aid. TradingPartnerPortalReg.pdf For more information, call or arxixnewsystem@hpe.com THE ARKANSAS FOUNDATION FOR MEDICAL CARE INC. (AFMC) IS UNDER CONTRACT WITH DXC TECHNOLOGY AND THE ARKANSAS DEPARTMENT OF HUMAN SERVICES (DHS), DIVISION OF MEDICAL SERVICES. THE CONTENTS PRESENTED MAY NOT BE THE SAME AS DXC OR ARKANSAS DHS POLICY. ARKANSAS DHS IS IN COMPLIANCE WITH TITLES VI AND VII OF THE CIVIL RIGHTS ACT. REVISED OCTOBER 2017 ARMEDICAID HEALTHCARE PORTAL : TRADING PARTNER ID ENROLLMENT PAGE 9 OF 9
REGISTERING ON THE PORTAL PROVIDER
PROVIDER PORTAL: Registering on the Portal Provider In order to take advantage of the enhancements of MMIS, providers should register on the Provider Portal. Users planning to perform the following must
EDI-ERA Provider Agreement and Enrollment Form (Page 1 of 5)
(Page 1 of 5) Please complete the following Mississippi Medicaid EDI ERA Provider Agreement and Enrollment Form. Please print or type. Complete all areas of the form, unless otherwise indicated. Once the
MISSISSIPPI MEDICAID ERA CONTRACT INSTRUCTIONS (SKMS0)
MISSISSIPPI MEDICAID ERA CONTRACT INSTRUCTIONS (SKMS0) An original signature is required. Please MAIL all pages of your completed and signed forms to: ABILITY ATTN: Enrollment One MetroCenter 4010 W. Boy
PAYER ID NUMBER SPECIAL NOTES. ELECTRONIC REGISTRATIONS Agreements Required SEND ENROLLMENT FORMS TO: ENROLLMENT CONFIRMATION
Page 1 of 1 4/17/2014 400 Vermillion Street Hastings, MN 55033 Ph 800-482-3518 Fax 651-389-9152 www.edsedi.com COLORADO MEDICAID EDI UPDATE DENTAL ELECTRONIC CLAIMS ENROLLMENT REGISTRATION PAYER ID NUMBER
220 Burnham Street South Windsor, CT Vox Fax OREGON MEDICAID DENTAL ELECTRONIC CLAIMS ENROLLMENT REGISTRATION
OREGON MEDICAID DENTAL ELECTRONIC CLAIMS ENROLLMENT REGISTRATION PAYER ID NUMBER CKOR1 SPECIAL NOTES Change Healthcare Dental signature is required. EDI packets must be mailed to Change Healthcare Dental
HIPAA 837 Claims EDI Agreement. Agreement. HIPAA 837 Claims EDI Agreement
HIPAA 837 Claims EDI Agreement Agreement All New Jersey Medicaid and Charity Care Providers desiring to submit HIPAA formatted electronic claims must complete a HIPAA 837 Claims EDI Agreement as required
ERA Enrollment Form Enrolling Through emomed
ERA Enrollment Rule 382 requires an electronic option for providers and trading partners to complete and submit the ERA enrollment effective January 1, 2014. An online ERA enrollment link from the emomed
Change Healthcare ERA Provider Information Form *This form is to ensure accuracy in updating the appropriate account
PAYER ID: SUBMITTER ID: 1 Provider Organization Practice/ Facility Name Change Healthcare ERA Provider Information Form *This form is to ensure accuracy in updating the appropriate account Provider Name
Change Healthcare CLAIMS Provider Information Form *This form is to ensure accuracy in updating the appropriate account
PAYER ID: SUBMITTER ID: 1 Provider Organization Practice/ Facility Name Change Healthcare CLAIMS Provider Information Form *This form is to ensure accuracy in updating the appropriate account Provider
Change Healthcare CLAIMS Provider Information Form *This form is to ensure accuracy in updating the appropriate account
PAYER ID: SUBMITTER ID: 1 Provider Organization Practice/ Facility Name Change Healthcare CLAIMS Provider Information Form *This form is to ensure accuracy in updating the appropriate account Provider
Change Healthcare ERA Provider Information Form *This form is to ensure accuracy in updating the appropriate account
PAYER ID: SUBMITTER ID: 1 Provider Organization Practice/ Facility Name Change Healthcare ERA Provider Information Form *This form is to ensure accuracy in updating the appropriate account Provider Name
HCPIR Job Aid Counselling Submissions. Purpose. Overview
Purpose As of April 1, 2019, the Health Care Provider Invoicing and Reporting (HCPIR) application is available to support Counselling practitioners. The HCPIR application is designed to streamline the
Mississippi Medicaid. Mississippi Medicaid Program Provider Enrollment P.O. Box Jackson, Mississippi Complete form and mail original to:
Mississippi Medicaid Complete form and mail original to: Blank forms may by copied. Call LTC at 888-941-8967 if you have questions. Please complete the following Mississippi Medicaid Provider EDI Enrollment
Electronic Remittance Advice (ERA) EDI Agreement
Electronic Remittance Advice (ERA) EDI Agreement (Form EDI-801) All New Jersey Medicaid and Charity Care Providers desiring to receive a HIPAA formatted electronic remittance advice (ERA) must complete
MASSACHUSETTS BCBS SB700 SUBMITTER ID - U076 12B14 SUBMITTER ID 00444PVRM
MASSACHUSETTS BCBS SB700 SUBMITTER ID - U076 12B14 SUBMITTER ID 00444PVRM https://provider.bluecrossma.com/providerhome/portal/home/forms/forms/era Instructions for Completing BCBSMA Electronic Remittance
HCPIR Job Aid Massage Therapy Submissions. Purpose. Overview
Purpose As of April 1, 2019, the Health Care Provider Invoicing and Reporting (HCPIR) application is available to support Massage Therapy practitioners. The HCPIR application is designed to streamline
JURISDICTION K NEW YORK MEDICARE CONTRACT INSTRUCTIONS (SMNY0 SMNY1 SMNY2)
CONTRACT Please read the following NGS Medicare instructions carefully in order to properly complete the enrollment forms. Incorrect or incomplete provider or submitter information will cause delays in
DDE PROFFESSIONAL CLAIMS
DDE PROFFESSIONAL CLAIMS SUBMISSION MANUAL Purpose: The EDI Portal application will enable Providers to bill and adjust claims electronically. To access the EDI Portal, logon to https://provider.kymmis.com
Data Type and Format (Not all data elements require a format specification)
Individual Data Element Name (Term) Sub-element Name (Term) Data Element Description Data Type and Format (Not all data elements require a format specification) Data Element Requirement for Health Plan
New York Medicaid Provider Resource Guide
New York Medicaid Provider Resource Guide Thank you for being a star member of our provider team. WellCare Health Plans, Inc., (WellCare) understands that having access to the right tools can help you
FedEDI REPORTING GUIDE
Introducing your new FedEDI REPORTING GUIDE Updated 12.15.17 Table of Contents SERVICE DESCRIPTION 3 DEFAULT REPORTS 3 REPORT DISTRIBUTION 3 REGISTRATION AND ENROLLMENT 3 REPORT TYPES 5 Return Item Report...7
ANSI ASC X12N 837 Healthcare Claim (Version X222A1-June 2010) Professional Companion Guide
ANSI ASC X12N 837 Healthcare Claim (Version 005010X222A1-June 2010) Pruitt Health Premier Missouri Medicare Select Signature Advantage September 2015 TABLE OF CONTENTS AT A GLANCE II CHAPTER 1: INTRODUCTION
MISSISSIPPI MEDICAID DENTAL ELECTRONIC CLAIMS ENROLLMENT REGISTRATION
220 Burnham Street South Windsor CT 06074 Vox 888-255-7293 Fax 860-289-0055 MISSISSIPPI MEDICAID DENTAL ELECTRONIC CLAIMS ENROLLMENT REGISTRATION PAYER ID NUMBER CKMS1 ELECTRONIC REGISTRATIONS Agreements
Instructions for Completing the Paper Electronic Remittance Advice (ERA) Enrollment Application
Instructions for Completing the Paper Electronic Remittance Advice (ERA) Enrollment Application General Instructions for completing the Paper ERA Enrollment Application: Please type or print legibly Complete
Authorization Agreement
Authorization Agreement For Electronic Health Care Claim Payment / Advice 835 Thank you for your interest in the Electronic Health Care Claim Payment/Advice (835), also known as Electronic Remittance Advice
FedEDI REPORTING GUIDE
Introducing your new FedEDI REPORTING GUIDE Updated 03.09.18 Table of Contents SERVICE DESCRIPTION 3 DEFAULT REPORTS 3 REPORT DISTRIBUTION 3 REGISTRATION AND ENROLLMENT 3 REPORT TYPES 5 Return Item Report...7
Trading Partner Account (TPA) Registration and Maintenance User Guide. for. State of Idaho MMIS
Trading Partner Account (TPA) Registration and Maintenance User Guide for State of Idaho MMIS Date of Publication: 3/8/2018 Document Number: RF019 Version: 5.0 This document and information contains proprietary
220 Burnham Street South Windsor, CT Vox Fax
NEVADA MEDICAID DENTAL ELECTRONIC REMITTANCE ADVICE (ERA) ENROLLMENT REGISTRATION PAYER ID NUMBER ELECTRONIC REGISTRATIONS AGREEMENTS REQUIRED CKNV1 Participation in Dental Electronic Remittance Advice
Electronic Visit Verification (EVV) Provider Selection Form Process for External Users
Electronic Visit Verification (EVV) Provider Selection Form Process for External Users Provider Vendor Selection 1) Navigate to TMHP.com 2) Click providers on first page of website to enter the provider
Provider Billing Agent/Clearinghouse EDI, Inc Authorization Form
Provider Billing Agent/Clearinghouse EDI, Inc Authorization Form Section A. Provider Information. Business Name Provider Name (Last, First, MI and Suffix) Provider Number Federal Tax ID Number Business
MEDICAID MARYLAND PART A (MCDMD) PRE-ENROLLMENT INSTRUCTIONS
MEDICAID MARYLAND PART A (MCDMD) PRE-ENROLLMENT INSTRUCTIONS WHAT FORM(S) SHOULD I DO? Maryland Medical Care Programs Submitter Identification Form Trading Partner Agreement o Both Forms must have original
220 Burnham Street South Windsor, CT Vox Fax
MISSISSIPPI MEDICAID DENTAL ELECTRONIC REMITTANCE ADVICE (ERA) ENROLLMENT REGISTRATION PAYER ID NUMBER SPECIAL NOTES ELECTRONIC REGISTRATIONS AGREEMENTS REQUIRED Dual Delivery of v5010 X12 835 and Proprietary
Medicare Advantage Provider Resource Guide
Medicare Advantage Provider Resource Guide Thank you for being a star member of our provider team. WellCare Health Plans, Inc., (WellCare) understands that having access to the right tools can help you
MASSACHUSETTS MEDICAID EDI CONTRACT INSTRUCTIONS (SKMA0)
MASSACHUSETTS MEDICAID EDI CONTRACT INSTRUCTIONS (SKMA0) Submit the completed Contract Setup Form to: ABILITY Network, ATTN: Enrollment FAX: 888.837.2232 EMAIL: setup@abilitynetwork.com INSTRUCTIONS Print
Change Healthcare ERA Provider Information Form *This form is to ensure accuracy in updating the appropriate account
PAYER ID: SUBMITTER ID: 1 Provider Organization Practice/ Facility Name Change Healthcare ERA Provider Information Form *This form is to ensure accuracy in updating the appropriate account Provider Name
1304 Vermillion Street Hastings, MN Ph Fax
Page 1 of 1 2/24/2014 NEW MEXICO MEDICAID DENTAL ELECTRONIC REMITTANCE ADVICE (ERA) ENROLLMENT REGISTRATION PAYER ID NUMBERS CKNM1 ELECTRONIC REGISTRATIONS AGREEMENTS REQUIRED CCD+ Reassociation SEND REGISTRATION
Change Healthcare CLAIMS Provider Information Form *This form is to ensure accuracy in updating the appropriate account
PAYER ID: SUBMITTER ID: 1 Provider Organization Practice/ Facility Name Change Healthcare CLAIMS Provider Information Form *This form is to ensure accuracy in updating the appropriate account Provider
New Jersey. NCPDP D.0/1.2 Payer Sheet. Page 1 of 41 January 2018 Version
New Jersey NCPDP D.0/1.2 Payer Sheet Page 1 of 41 Table of Contents Section 1 Version History... 3 Section 2 Introduction... 6 2.1 New Jersey DMAHS Introduction... 6 2.2 HIPAA Background... 7 Section 3
Early Intervention Indiana First Steps Indiana First Steps HIPAA Testing Plan
Testing and Certifying HIPAA Compliance with Transaction Sets Contingency Testing Plan... 2 Testing Description... 2 Testing Procedures for Providers/Payees... 3 Testing Protocols... 4 Six Plus One Levels
Refers to the Technical Reports Type 3 Based on ASC X12 version X223A2
HIPAA Transaction Standard Companion Guide For Availity Health Information Network Users Refers to the Technical Reports Type 3 Based on ASC X12 version 005010X223A2 837 Health Care Claim Institutional
RETAIL PRODUCER PORTAL
RETAIL PRODUCER PORTAL This presentation is a high-level summary and for general informational purposes only. The information in this presentation is not comprehensive and does not constitute legal, tax,
Change Healthcare CLAIMS Provider Information Form *This form is to ensure accuracy in updating the appropriate account
PAYER ID: SUBMITTER ID: 1 Provider Organization Practice/ Facility Name Change Healthcare CLAIMS Provider Information Form *This form is to ensure accuracy in updating the appropriate account Provider
TRICARE PGBA, LLC Electronic Data Interchange PO Box Augusta, GA Fax: Phone , Option #2
TRICARE PGBA, LLC Fax: 803-264-9864 Phone 1-800-325-5920, Option #2 Dear Provider: Thank you for your interest in Electronic Remittance Advice (ERA) with PGBA, LLC. We also offer Electronic Funds Transfer
Guide to the X214 Claim Acknowledgement Conduent EDI Solutions, Inc.
Mississippi Medicaid Companion Guide to the 005010X214 Claim Acknowledgement Conduent EDI Solutions, Inc. ANSI ASC X12N 277CA October 2017 TABLE OF CONTENTS AT A GLANCE II CHAPTER 1: INTRODUCTION 3 Audience
Table of Contents. Page 2 of 49
Web Portal Quick Reference Guide www.dc-medicaid.com Revised: 12/11/2017 Table of Contents Accessing the Web Portal... 3 Web Account Registration... 4 Inquiry Options... 6 Searching for Ordering/Referring
CORE-required Maximum EFT Enrollment Data Set
CORE-required Maximum EFT Data Set The following table is taken directly from CORE Operating Rule 380 and identifies all details related to the fields contained within this document. Individual Data Element
Trading Partner Account (TPA) User Guide. for. State of Idaho MMIS
Trading Partner Account (TPA) User Guide for State of Idaho MMIS Date of Publication: 3/8/2018 Document Number: RF019 Version: 4.0 This document and information contains proprietary information and copyrighted
BCBS LOUISIANA (53120) PRE-ENROLLMENT INSTRUCTIONS
BCBS LOUISIANA (53120) PRE-ENROLLMENT INSTRUCTIONS WHAT FORM(S) SHOULD I DO? BCBS LA Business Associate Profile Electronic Remittance Advice (ERA) Enrollment form If you would like to receive ERAs through
MEDICAID DISTRICT OF COLUMBIA (77033) PRE-ENROLLMENT INSTRUCTIONS
MEDICAID DISTRICT OF COLUMBIA (77033) PRE-ENROLLMENT INSTRUCTIONS WHAT FORM(S) SHOULD I DO? Xerox EDI Provider Enrollment Form WHERE SHOULD I SEND THE FORM(S)? ; or Mail form to: WHAT IS THE TURNAROUND
Change Healthcare ERA Provider Information Form *This form is to ensure accuracy in updating the appropriate account
THE 2018 HNFS ENROLLMENT IS ALSO REQUIRED WHEN FILLING THIS OUT PAYER ID: SUBMITTER ID: 1 Provider Organization Practice/ Facility Name Change Healthcare ERA Provider Information Form *This form is to
VI. CLAIMS EDI PROCESSING PROCEDURES A. General Information
A. General Information Electronic submission of claims helps to speed the processing and ensure accuracy and security. While direct submission of claims is allowed, this option is more practical for large
Railroad Medicare Electronic Data Interchange Application
Electronic Data Interchange Application Action Requested: Add New EDI Provider(s) Change/Update Submitter Information Apply for New Submitter ID Apply for New Receiver ID Delete Date: Submitter ID: ERN
220 Burnham Street South Windsor, CT Vox Fax
WASHINGTON BLUE CROSS BLUE SHIELD (PREMERA) DENTAL ELECTRONIC REMITTANCE ADVICE (ERA) ENROLLMENT REGISTRATION PAYER ID NUMBER 47570 ELECTRONIC REGISTRATIONS AGREEMENTS REQUIRED CCD+ REASSOCIATION SEND
835 Health Care Claim Payment and Remittance Advice Companion Guide X091A1
835 Health Care Claim Payment and Remittance Advice Companion Guide 004010 X091A1 Version 1.3 March 1, 2008 1-March-2008 TABLE OF CONTENTS 1 Introduction... 1 1.1 Purpose... 1 2 Transmission and Data Retrieval
Group Provider Enrollment Tutorial. Revised 4/5/18
Group Provider Enrollment Tutorial Revised 4/5/18 1 Group Provider Enrollment Documents you will need: Copy of Confirmation Letter or email from the National Plan and Provider Enumeration System (NPPES)
PROVIDER PORTAL. NEW USER/REFRESHER LEARNING PROVIDER PORTAL OVERVIEW Module
PROVIDER PORTAL NEW USER/REFRESHER LEARNING PROVIDER PORTAL OVERVIEW Module WELCOME TO THE PROVIDER PORTAL Dean Health Plan recognizes the importance for our Providers to simplify everyday tasks, promote
MEDICAID PENNSYLVANIA ERA ENROLLMENT INSTRUCTIONS - MCDPA
MEDICAID PENNSYLVANIA ERA ENROLLMENT INSTRUCTIONS - MCDPA HOW LONG DOES PRE-ENROLLMENT TAKE? Please allow four (4) weeks for the enrollment application process. If after five (5) weeks you do not start
MEDICARE IDAHO PRE ENROLLMENT INSTRUCTIONS MR003
MEDICARE IDAHO PRE ENROLLMENT INSTRUCTIONS MR003 HOW LONG DOES PRE ENROLLMENT TAKE? Standard Processing time is 3 4 weeks WHERE SHOULD I SEND THE FORMS? Fax the form to Office Ally at 360 896 2151, or;
Basic Tasks for Managing an Account on the TMHP Secure Provider Portal
Basic Tasks for Managing an Account on the TMHP Secure Provider Portal TMHP Secure Portal Administration Job Aid v2017_0906 Contents Creating a Secure Provider Account on the TMHP Portal 3 Enroll a New
ELECTRONIC FUNDS TRANSFER (EFT) For Provider Payments
ELECTRONIC FUNDS TRANSFER (EFT) For Provider Payments Alameda Alliance for Health is pleased to announce the availability of Electronic Funds Transfer (EFT). Providers who enroll in EFT will have Fee-For-Service
220 Burnham Street South Windsor, CT Vox Fax
220 Burnham Street South Windsor, CT 06074 Vox 888-255-7293 Fax 860-289-0055 KANSAS MEDICAID DENTAL ELECTRONIC REMITTANCE ADVICE (ERA) ENROLLMENT REGISTRATION PAYER ID NUMBER CKKS1 SPECIAL NOTES 1. Upon
Welcome to the. Patient Portal!
Welcome to the Patient Portal! You re about to find out just how easy it can be to communicate with your healthcare provider, schedule and request appointments, take control of your medical information,
Batch Eligibility Long Term Care claims
DXC Technology Provider Electronic Solutions software lets Connecticut Medical Assistance Program providers verify patient s eligibility and submit and correct claims for services all electronically. The
MEDICAID FLORIDA ELECTRONIC REMITTANCE ADVICE ENROLLMENT INSTRUCTIONS 77027
MEDICAID FLORIDA ELECTRONIC REMITTANCE ADVICE ENROLLMENT INSTRUCTIONS 77027 HOW LONG DOES PRE-ENROLLMENT TAKE? Please allow 3 weeks for processing. HOW DO I ENROLL / WHAT FORM(S) SHOULD I DO? Option 1:
MEDICAID MARYLAND PRE-ENROLLMENT INSTRUCTIONS MCDMD
MEDICAID MARYLAND PRE-ENROLLMENT INSTRUCTIONS MCDMD HOW LONG DOES PRE-ENROLLMENT TAKE? Standard processing time is 2 weeks. WHAT FORM(S) SHOULD I COMPLETE? Maryland Medical Care Programs Submitter Identification
TRICARE West Region Electronic Data Interchange PO Box Augusta, GA Fax:
Dear Provider: Thank you for your interest in Electronic Remittance Advice (ERA) with PGBA, LLC. Please take a moment to review the enrollment guidelines (Appendix A). Once you have reviewed the guidelines,
WV MMIS EDI File Exchange User Guide Version 1.0 West Virginia Trading Partner Account Electronic Data Interchange (EDI) File Exchange User Guide
West Virginia Trading Partner Account Electronic Data Interchange (EDI) File Exchange User Guide Date of Publication: 01/19/2016 Document Version: 1.0 Privacy and Security Rules WV MMIS The Health Insurance
EDI ENROLLMENT AGREEMENT INSTRUCTIONS
EDI ENROLLMENT AGREEMENT INSTRUCTIONS The Railroad EDI Enrollment Form (commonly referred to as the EDI Agreement) should be submitted when enrolling for electronic billing. It should be reviewed and signed
New Account Application
*Required fields Date: 3/12/2018 GENERAL ACCOUNT DETAILS *Billing Name and Address City State Postal Code *Shipping Name and Address City State Postal Code Tel# Tel# Email Email Contact Name Contact Name
Health Care Connectivity Guide
Health Care Connectivity Guide Standard Companion Guide November 2, 2015 Version 2.0 Disclosure Statement The Kansas Department of Health and Environment (KDHE) is committed to maintaining the integrity
UCARE 835 ERA PRE ENROLLMENT INSTRUCTIONS 52629
UCARE 835 ERA PRE ENROLLMENT INSTRUCTIONS 52629 HOW DO I ENROLL TO RECEIVE 835s/ERAs? STEP 1: Complete the Availity Multi Payer ERA Enrollment Form. (Standard processing time is 1 week) Fax the form to
Jaggaer Supplier - Job Aid
Audience and Purpose: This guide is intended for external suppliers wishing to do business with WM. The job aid outlines the necessary steps for a supplier to register in Waste Management s supplier onboarding
Guide to Completing the Electronic Remittance Advice (ERA) Enrollment Form
Guide to Completing the Electronic Remittance Advice (ERA) Enrollment Form The ERA service enables Blue Cross and Blue Shield of Louisiana to provide you with an electronic remittance advice, which is
EZClaim Premier ANSI 837P TriZetto Clearinghouse Manual
EZClaim Premier ANSI 837P 5010 TriZetto Clearinghouse Manual EZClaim Medical Billing Software November 2016 TriZetto Site ID# TriZetto SFTP Password Trizetto Website login Password Enrollment Process for
MEDICAID MARYLAND PRE ENROLLMENT INSTRUCTIONS MCDMD
MEDICAID MARYLAND PRE ENROLLMENT INSTRUCTIONS MCDMD HOW LONG DOES PRE ENROLLMENT TAKE? Standard processing time is 2 weeks. WHAT FORM(S) SHOULD I COMPLETE? Maryland Medical Care Programs Submitter Identification
Provider Portal User Guide
Provider Portal User Guide Updated: January 1, 2019 Table of Contents Introduction... 1 How to Register for the Provider Portal... 3 Manage Your Profile... 5 User Administration... 8 Authorizations & Referrals...
BCBS LOUISIANA PRE-ENROLLMENT INSTRUCTIONS 53120
BCBS LOUISIANA PRE-ENROLLMENT INSTRUCTIONS 53120 HOW LONG DOES PRE-ENROLLMENT TAKE? Standard Processing time is 3 business days WHAT FORM(S) DO I COMPLETE? BCBS LA EDI Transaction Addendum Business Associate
Arkansas All-Payer Claims Database (APCD) Onboarding Packet
Arkansas All-Payer Claims Database (APCD) Onboarding Packet October 2018 Introduction The onboarding packet contains information for submitting entities (SEs) to establish connectivity for secure data
Welcome to the. Patient Portal!
Welcome to the Patient Portal! You re about to find out just how easy it can be to communicate with your healthcare provider and take control of your medical information. Using this quick reference guide,
220 Burnham Street South Windsor, CT Vox Fax
NEW HAMPSHIRE MEDICAID DENTAL ELECTRONIC REMITTANCE ADVICE (ERA) ENROLLMENT REGISTRATION PAYER ID NUMBER SPECIAL NOTES CKNH1 ERAs can only be sent to one Trading Partner, if a provider has previously requested
Availity TM Electronic Remittance Advice
Availity TM Electronic Remittance Advice Electronic Remittance Advice (ERA) or ANSI 835 is a HIPAA-compliant method of receiving claim payment and remittance details from Blue Cross and Blue Shield of
Community Services Group Employee Portal
Community Services Group Employee Portal https://csgonline.greenemployee.com/ Logging in to GreenEmployee.com Please use the above link to take you directly to a sign-in page or on the Insider you can
MEDICARE Texas (TRAILBLAZERS) PRE-ENROLLMENT INSTRUCTIONS 00900
MEDICARE Texas (TRAILBLAZERS) PRE-ENROLLMENT INSTRUCTIONS 00900 HOW LONG DOES PRE-ENROLLMENT TAKE? Standard processing time is 5 business days after receipt. WHAT FORM(S) SHOULD I COMPLETE? EDI Provider
CURRENT INVOICE DOWNLOAD: 1. From the homepage, click on Billing Inquiry. 2. On the right under Invoices and Receipts, click on View Current Invoice.
Employer Billing Functions From the online group leader account homepage, you have complete flexibility and control over all aspects of your organization s account information. Clearly labeled navigation
TEXAS MEDICARE (TRAILBLAZERS) CHANGE FORM MR085
TEXAS MEDICARE (TRAILBLAZERS) CHANGE FORM MR085 HOW LONG DOES PRE-ENROLLMENT TAKE? Standard processing time is 20 days WHAT PROVIDER NUMBERS DO I USE? Six digit Medicare legacy provider ID NPI Number WHAT
Part B. NGSConnex User Guide. https:/www.ngsconnex.com. Visit our YouTube Channel to view all of our videos! https://www.youtube.com/user/ngsmedicare
NGSConnex User Guide Part B This guide provides information for our Part B providers on the different options available within our self-service portal, NGSConnex. https:/www.ngsconnex.com Visit our YouTube
6. CLAIMS EDI PROCESSING PROCEDURES A. General Information
A. General Information A. Electronic submission of claims helps to speed processing and ensure accuracy and security. While direct submission of claims is allowed, this option is more practical for large
Using the New CDSP Online epay System
Using the New CDSP Online epay System CDSP s new online payment system offers many benefits, including a comprehensive view of all invoices and payments applied to your account, the ability to use credit
H835/U277 Request for Electronic Remittance Advice (ERA) (8/21/2013 revision)
H835/U277 Request for Electronic Remittance Advice (ERA) (8/21/2013 revision) Instructions: The purpose of this form is to comply with the Phase III CORE 382 ERA Enrollment Data Rule version 3.0.0 June
Electronic Payments & Statements (EPS) Frequently Asked Questions (FAQs)
Electronic Payments & Statements (EPS) Frequently Asked Questions (FAQs) As of August 25, 2014, your PAF reimbursements can be made by direct deposit. How do I enroll for direct deposit? You can enroll
WELCOME TO OFFICE ALLY!
WELCOME TO OFFICE ALLY! BCBS KANSAS / BCBS KANSAS CITY / MEDICARE OF KANSAS CITY PRE-ENROLLMENT INSTRUCTIONS HOW LONG DOES PRE-ENROLLMENT TAKE? O 3-5 business days WHAT PROVIDER NUMBER DO I USE? O Provider
Part A/Part B/HHH EDI Enrollment (Agreement) Form and Instructions
Part A/Part B/HHH EDI Enrollment (Agreement) Form and Instructions The EDI Enrollment Form (commonly referred to as the EDI Agreement) should be submitted when enrolling for electronic billing. It should
Ohio Medicare Part B Change Form
Ohio Medicare Part B Change Form Change form for currently enrolled providers changing to new clearinghouse(ltc). Complete the form, sign, and mail original to: CGS 1 Cameron Hill Cir STE 0061 Chattanooga,
Infinedi, LLC. Frequently Asked Questions
Infinedi, LLC Frequently Asked Questions Who are we? Infinedi has been helping medical providers better manage their practices since 1986 by providing the finest EDI services available. Infinedi is a privately
220 Burnham Street South Windsor, CT Vox Fax
NEBRASKA MEDICAID DENTAL ELECTRONIC REMITTANCE ADVICE (ERA) ENROLLMENT REGISTRATION PAYER ID NUMBER SPECIAL NOTES CKNE1 Paper Remittance Advice Statements and Refund Request Reports statements will cease
Employee User Guide What Employees Need to Know About Using the Burnham & Flower Wealthcare
Employee User Guide What Employees Need to Know About Using the Burnham & Flower Wealthcare Table of Contents Getting started...2 My accounts...3 My expenses...13 Communications...15 Enrollment...17 Resources...21
BLUE CROSS BLUE SHIELD LOUISIANA (53120) ERA ENROLLMENT INSTRUCTIONS
BLUE CROSS BLUE SHIELD LOUISIANA (53120) ERA ENROLLMENT INSTRUCTIONS WHAT FORM(S) SHOULD I DO? Electronic Remittance Advice (ERA) Enrollment Form WHERE SHOULD I SEND THE FORM(S)? Email to: edich@bcbsla.com;
HIPAA Implementation: Steps to Creating a Budget for HIPAA Compliance
HIPAA Implementation: Steps to Creating a Budget for HIPAA Compliance Presented By: Steven S. Lazarus, PhD, FHIMSS Boundary Information Group 4401 South Quebec Street, #100 Denver, CO 80237 (303) 488-9911
JURISDICTION 11 EDI CONTRACT INSTRUCTIONS
JURISDICTION 11 EDI CONTRACT INSTRUCTIONS Submit the completed form to: ABILITY Network, ATTN: Enrollment FAX: 888.837.2232 EMAIL: setup@abilitynetwork.com INSTRUCTIONS Refer to these instructions as you