Medicare EDI Support

Medicare EDI Support Program

Medicare EDI Support is released by A/B Medicare Administrative Contractors (MACs) and Durable Medical Equipment (DME) MACs as well as the DME MAC Common Electronic Data Interchange (CEDI) contractor. Medicare EDI Support is provided for physicians, suppliers and other providers that submit claims and conduct other Health Insurance Portability and Accountability Act (HIPPA) of 1996 named electronic business with the Medicare Part A and Part B program.

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.

Providers, billing services, clearinghouses, or other entities that furnish services to providers, shall contact the following:

  • For professional claims, by geographic area in which the provider operates.
  • For institutional claims, by geographic area in which the institution operates.
  • For durable medical equipment claims (DME MAC or CEDI), by zip code of a beneficiary that receives services or supplies billed to.
  • Use of EDI transactions allows a provider to submit transactions faster and be paid for claims faster, and to accomplish this at a lower cost than is generally the case for paper or manual transactions.

Medicare contractors can assist partners to begin exchanging EDI transactions by furnishing them with enrollment and connectivity information, system access numbers and passwords, information on those transactions supported by Medicare Part A and Part B, and testing with you to assure correct transmission of the EDI formats. Although these contractors can supply limited EDI training, it is the responsibility of physicians, suppliers and other providers and other entities that will be using EDI to train their staff members on use of the hardware, software, and the security and privacy requirements that apply to HIPAA EDI transactions.

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