Nevada Medicaid: FHSC

Please follow the Enrollment Instructions below to become an electronic submitter for Nevada Medicaid.

Required Documents for those applying for new Submitter IDs

The following documents are required enrollment documents that must be completed, signed and returned to the FHSC office prior to initiation of electronic claims submission or inquiry.

1. FH-35 Electronic Transaction Agreement for Service Centers
2. FH-36 Service Center Operational Information
3. FH-37 Service Center Authorization Form for Providers
4. One Public SSH Key (we provide to you)

If the links above do not work properly, please download the forms from here:
http://www.medicaid.nv.gov/providers/edi.aspx

If you have any questions regarding any of the documents in this package, please call the FHSC EDI Technology Support Center at 1-877-638-3472.

Our Vendor Information

Vendor Name - AXIOM Systems, Inc.
Contact - EDI Team
Vendor Code - N/A
Phone - 602-439-2525
Fax - 602-439-0808
Address - 241 East 4th Street, Suite 200
Frederick, MD 21701
Software Name - SolAce EMC
E-mail - Support@SolAce-emc.com

FH-35 Electronic Transaction Agreement for Service Centers

Section 1: Submitter Information

  • Enter your Business/Practice or Provider name
  • City, State, Zip
  • Current Date

Section 2: Signature

  • Sign and Date the bottom of this form

FH-36 Service Center Operational Information

Section 1: General

  • Please select “ I am enrolling with HPES as a Service Center for the first time”

Section 2: Contact Information

  • Please enter your Business/Practice or Provider name
  • Address
  • Phone and Fax numbers
  • Name and Email of the main Contact person for your office

Section 3: Electronic Transaction Types

  • Remittance Advice (835) – To receive your EOBs electronically in SolAce
  • Professional (837 P) – For CMS 1500 claims
  • Institutional (837 I) – For UB04 claims

Section 4:

  • Please call us for IP address and ports, as it will depend on the version of SolAce you are using

Section 5: Software Vendor Information

  • Please complete the Software Vendor Information provided above.

FH-37 Service Center Authorization Form for Providers

NOTE: This form must be filled out for EACH Provider Medicaid Number that will be submitting electronic claims.

  • Check the Box that says “I will submit claims directly from my business to HP Enterprise Services (direct submitter)”
  • Enter your Business/Practice or Provider Name. Leave the SC Code field blank.
  • Please select the following transactions to Authorize that apply to your needs:
    • Professional claim – CMS 1500 claims
    • Institutional claim – UB04 claims
    • Remittance Advice – Remittance Advice
    • Claim Status Request/Response (276/277)
  • Do not fill out the next section below about “Terminating a Transaction”

Signature Section

  • Enter Practice or Provider name
  • Enter Provider’s NPI and Tax ID
  • Check the appropriate response
  • Enter Authorized Signature

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records. Mail the enrollment forms reflecting original signatures to:

HP Enterprise Services
EDI Coordinator
PO Box 30042
Reno, Nevada 89520-3042

It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt. (Remember that mailing time can take as much as five days.)

After processing, a confirmation will be email to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the FHSC EDI Technology Support Center at 1-877-638-3472.

Testing

Once you have received your Submitter ID and Password from FHSC, please call the SolAce Support Team. We will need to assign you a SSH Key and set an appointment for a Mailbox setup and Test Transmission.

Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.

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customers From our customers

I am very pleased with our SolAce billing software and how easy it is to navigate. They have a great team who can train you to do billing even if you don’t have billing experience. Special thanks to Cathy, Gigi, and Skyler who always helps me out every time I have issues.

Shani Madaminova,
Administrator
Best Home Care, Inc
Jersey City, NJ

SolAce is awesome software. I absolutely LOVE it. For over three years I have used this software daily for multiple long term care facilities to submit claims to various MACs, Medicaid, and Medicare Advantage and Supplemental Insurance carriers. It is convenient, simple to use and far less costly than any Clearing House software I had explored. The ability to import from my Practice Management Software and Therapy Providers has reduced any RTP claims edits and denials are a thing of the past. Customer Support is “Johnny on the spot”, but terrific as they may be, it gets better - RARELY do I need to call. LOVE IT, LOVE IT, AND LOVE IT.

Susie Doran Carter, Westcare Management, Inc.
LTC Medicare Consultant and Billing Service
Salem, OR

I think our medical office was one of the first to use SolAce in the mid 1990’s and we are still using it today for all of our electronic billing because it works ! It was simple for our staff to learn and it integrated easily with our accounting/billing program. It has been especially nice to know that the Axiom staff is there when Medicare changes something and they are right on it. They made the 5010 change a simple process plus made educational seminars available to us. Thank you to all the Axiom/ Ivertex professionals who have helped us for the last 15+ years.

Carolyn Boles
From the office of Donald J. Boles Jr. MD PC
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SolAce has been a valuable tool that has been a life saver for my billing service for years. It has allowed me to bill professional and institutional claims with ease. Customer service @ SolAce is top rated in my opinion. The SolAce product is very user friendly and affordable. Thank you SolAce team for a great product.

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Idabel, Oklahoma

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IT Administrator
THE WYNN GROUP, INC
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