Medicare EDI Enrollment

Medicare EDI Enrollment General Requirements

Medicare EDI Enrollment should be started with the Enrollment Form. The Centers for Medicare & Medicaid Services (CMS) Standard Electronic Data Interchange (EDI) Enrollment Form (Medicare EDI Enrollment Form) must be completed prior to submitting electronic media claims (EMC) or other EDI transactions to Medicare. The agreement must be executed by each provider of health care services, physician, or supplier that intends to submit EMC or use EDI, either directly with Medicare or through a billing service or clearinghouse.

Each new Medicare EDI biller must sign the form and submit it to their local Medicare Administrative Contractor (MAC) or Durable Medicare Equipment (DME) MAC. For more information regarding the CMS Standard Medicare EDI Enrollment Form, contractors should contact their local A/B MAC or DME MAC.

An organization comprising of multiple components that have been assigned Medicare provider numbers, supplier numbers, or UPINs may elect to execute a single Medicare EDI Enrollment Form on behalf of the organizational components to which these numbers have been assigned. The organization as a whole is held responsible for the performance of its components.

The information in this blog is intended for the use of health care providers, clearinghouses and billing services that submit transactions to or receive transactions from Medicare fee-for-service contractors. EDI is the automated transfer of data in a specific format following specific data content rules between a health care provider and Medicare, or between Medicare and another health care plan. In some cases, that transfer may take place with the assistance of a clearinghouse or billing service that represents a provider of health care or another payer. EDI transactions are transferred via computer either to or from Medicare. Through use of EDI, both Medicare and health care providers can process transactions faster and at a lower cost.

Leave a Reply

Your email address will not be published.

Post Navigation