EDI Enrollment and Registration

EDI Enrollment and Registration (Trading Partner Agreements Basics)

EDI Enrollment and Registration basics state that Medicare FFS’ Trading Partner Agreement is comprised of two forms: 1) EDI Registration and 2) EDI Enrollment.

A/B MACs and CEDI must use these two forms, or their own organization specific forms given they are comparable in terms of content, to transmit data files electronically between themselves and their trading partners. EDI registration and enrollment shall be instituted by the A/B MACs and CEDI and shall accomplish the following:

  • Document the specific type of transactions and transmission methods to be utilized and secure authorizations from the provider or other trading partner requesting to exchange electronic administrative transactions, and
  • Designate the A/B MACs and CEDI with whom the provider or other trading partner agrees to engage in EDI and implements standard policies and practices to ensure the security and integrity of the information to be exchanged.

Under HIPAA, EDI applies to all covered entities transmitting the following administrative transactions:

  • ASC X12 837 institutional claim and ASC X12 837 professional claim,
  • ASC X12 835 remittance advice,
  • ASC X12 270/271 eligibility,
  • ASC X12 276/277 claim status and NCPDP claim (and others that are not used by Medicare at this time).

Beginning on January 1, 2012, A/B MCs and CEDI will also use the ASC X12 TA1 interchange  acknowledgment, ASC X12 999 implementation acknowledgment and ASC X12 277CA claim acknowledgment error handling transactions. In addition, CEDI and DME MACs will also use the NCPDP standard transmission response transaction. Entities who prepare and submit the CMS 1500 or CMS 1450 paper claim forms do not need to complete an EDI registration.

A provider must obtain an NPI and furnish that NPI to their A/B MAC and CEDI prior to completion of an initial EDI Enrollment Agreement and issuance of an initial EDI number and password by that contractor. A provider’s EDI number and password serve as a provider’s electronic signature and the provider would be liable if any entity with which the provider improperly shared the ID and password performed an illegal action while using that ID and password.

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