Medicare EDI Enrollment

New Medicare EDI Enrollments The Medicare EDI Enrollment 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 Read More →

EDI Enrollment

EDI Enrollment Procedures (CMS) A/B MACs and CEDI are required to furnish new providers that request Medicare claim privileges information on EDI. A/B MACs and CEDI are required to assess the capability of entities to submit data electronically, establish their qualifications, and enroll and assign submitter EDI identification numbers to those approved to use EDI. Read More →


EDI Enrollment and Registration (AKA Trading Partner Agreements) Medicare FFS’ Trading Partner Agreement is comprised of two forms: 1) EDI Registration and 2) EDI Enrollment. The forms are identified under CMS form 10164 and can be accessed at: EDI Registration EDI Enrollment A/B MACs and CEDI must use these two forms, or their own organization Read More →

HIPAA EDI Standard

HIPAA EDI Standard History EDI is the process of using nationally established standards to exchange electronic information between business entities. These national standards are developed and maintained by a group of standards development organizations (SDOs), such as the Accredited Standards Committee (ASC) X12 and the National Council of Prescription Drug Programs (NCPDP). The Department of Health Read More →

EDI Forms Solution

EDI Forms Solution (Pennsylvania Bureau of Workers’ Compensation’s (BWC) strategy) This blog describes the strategy to implement EDI Forms Solution. Please note that the BWC claim forms referred to in the below sections refer to only the following four forms: EDI Form Description LIBC-495 NOTICE OF COMPENSATION PAYABLE LIBC-496 NOTICE OF WORKERS’ COMPENSATION DENIAL LIBC-501 NOTICE OF Read More →

HIPAA EDI Webinars

HIPAA EDI Webinars Schedule HIPAA EDI 101 – Introduction To The Health Care EDI Environment Webinar Times: Mondays at 03:00 PM – 04:30 PM EST – 2020 Dates: October 26th or December 7th Register a la carte: Introduction to the Health Care EDI Environment Health Care EDI Defined Benefits of Health Care EDI X12 Read More →

BWC Testing

Testing Procedures Completion BWC Testing Completion is the final step of testing between direct-filing Trading Partners and/or EDI Transaction Partners and BWC. During this step direct-filing Trading Partners and/or EDI Transaction Partners will be given formal approval by BWC to proceed with its system updates to their respective production environments. Additional test cycles will need to be conducted if direct-filing Read More →

EDI Claims Codes

EDI LIBC-495 (Notice of Compensation Payable – BWC) EDI LIBC-495 verifies if the Claim Administrator has implemented the changes that would result in the generation of the Notice of Compensation Payable (LIBC-495) based on the following EDI transaction/maintenance type codes: SROI IP SROI PY SROI AP SROI RB SROI 02 SROI CA SROI PD SROI IP 1. Read More →


EDI LIBC-501 (Notice of Temporary Compensation Payable) The purpose of EDI LIBC-501 is to verify if the Claim Administrator has implemented the changes that would result in the generation of the Notice of Temporary Compensation Payable (LIBC-501) based on the following EDI transaction/maintenance type codes: SROI IP SROI PY SROI AP SROI RB SROI RE SROI 02 SROI PD SROI Read More →

PRV Taxonomy Codes Segment

PRV Taxonomy Codes Segment Description The PRV Taxonomy Codes segment is used to the provider type by a 10-digit identification number known as a Taxonomy-Specialty code.  These codes are used by the health plan’s claim adjudication logic. The X12 standard says this segment is required only if the payer’s adjudication is known to be impacted Read More →