Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI).

Required Documents for those applying for new Submitter IDs

The following documents are required enrollment documents that must be completeed signed, and returned to the Rhode Island BCBS office prior to initiation of electronic claims submission or inquiry. 1. Trading Partner Registration Form 2. Trading Partner Agreement If the above links do not work properly, please download these forms from:

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI).

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 DHS office prior to initiation of electronic claims submission or inquiry. 1. EDI Registration Form 2. Application for Authorization Form 3. Trading Partner Agreement

Required Documents for those with existing Submitter Ids but need to make changes to their account:

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI). If you are a contracted provider and have not received your Internet Pin letter, please call our Internet Help Desk at (405)522-6205 or (800)522-0114, select option 2, then option 1 to request your Pin.

Required Documents for those applying for new Submitter Id's

The following documents are required enrollment documents that must be completed, signed, and returned to the EDS office prior to initiation of electronic claims submission or inquiry. 1. DI/ERA Application for Providers

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI).

Required Documents for those applying for new Submitter ID's

The following documents are required enrollment documents that must be completed, signed and returned to the BCBS office prior to initiation of electronic claims submission or inquiry. 1. Trading Partner Agreement 2. Electronic Connectivity Request Form:
  • ECR-837, 27X, 835
    • If the links above do not work properly, you can download them from:

    Enrollment Instructions

    Thank you for your interest in Electronic Data Interchange (EDI).

    Required Documents for those applying for new Submitter ID's

    Part A

    The following documents are required enrollment documents that must be completed prior to initiation of electronic claims submission or inquiry. The first 3 forms must be completed in order to transmit claims electronically to NGS. Form #4 can be completed all by itself if all that is needed is access to the FISS/DDE System. 1. EDI Submitter Action Request Form

    Enrollment Instructions

    Thank you for your interest in Electronic Data Interchange (EDI).

    Required Documents for those applying for new Submitter ID's

    Part A

    The following documents are required enrollment documents that must be completed prior to initiation of electronic claims submission or inquiry. The first 3 forms must be completed in order to transmit claims electronically to NGS. Form #4 can be completed all by itself if all that is needed is access to the FISS/DDE System. 1. EDI Submitter Action Request Form

    Enrollment Instructions

    Thank you for your interest in Electronic Data Interchange (EDI).

    Required Documents for those applying for new Submitter ID's

    Part A

    The following documents are required enrollment documents that must be completed prior to initiation of electronic claims submission or inquiry. The first 3 forms must be completed in order to transmit claims electronically to NGS. Form #4 can be completed all by itself if all that is needed is access to the FISS/DDE System. 1. EDI Submitter Action Request Form

    Enrollment Instructions

    Thank you for your interest in Electronic Data Interchange (EDI).

    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 NHIC office prior to initiation of electronic claims submission or inquiry. Part A 1. EDI Enrollment Form 2. Submitter Action Request Form

    Enrollment Instructions

    Thank you for your interest in Electronic Data Interchange (EDI).

    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 NHIC office prior to initiation of electronic claims submission or inquiry. Part A 1. EDI Enrollment Form 2. Submitter Action Request Form

    Enrollment Instructions

    Thank you for your interest in Electronic Data Interchange (EDI).

    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 NHIC office prior to initiation of electronic claims submission or inquiry. Part A 1. EDI Enrollment Form 2. Submitter Action Request Form

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