EDI Medicare Enrollments: New Enrollments and Maintenance of Existing Enrollments

EDI Medicare EnrollmentsEDI Medicare Enrollments process provides for collection of the information needed to successfully exchange EDI transactions between Medicare and EDI trading partners and also establishes the expectations for both parties in the exchange. This agreement must be executed by each provider that submits/receives EDI either directly to or from Medicare or through a third party. Each provider that will use EDI either directly or through a billing agent or clearinghouse to exchange EDI transactions with Medicare must sign the EDI Enrollment Form and submit it to the A/B MAC or CEDI with which EDI transactions will be exchanged before the A/B MAC, or CEDI will accept claims or other incoming EDI transactions from that provider, or a third party for that provider, or send outbound EDI transactions. A/B MACs and CEDI may accept a signed Medicare EDI Enrollment Form from providers via fax, email, internet portal, or hard copy and may accept electronic signature formats, “wet”, or a combination of the two. The EDI Enrollment Form is effective as specified in the terms of the agreement.

Providers who will be accessing the A/B MACs Direct Data Entry (DDE) system will have access to enter and correct claims directly at the A/B MAC and must submit an EDI Enrollment Form to A/B MAC with their request for this access.

EDI Medicare Enrollments Notes 

  • Although a type of electronic transaction, electronic funds transfers (EFTs) between an A/B MAC or DME MAC and a bank are not considered EDI for Medicare EDI Enrollment Form purposes. A provider that uses EFT but no EDI transactions should not complete an EDI Enrollment Form.
    2. Medicaid state agencies are not required to complete a Medicare EDI Enrollment Form as a condition for receipt of COB claims.

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