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

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 CGS office prior to initiation of electronic claims submission or inquiry. 1. J15 EDI Enrollment Packet In this packet you will be filling out the following forms:
  • EDI Application
  • EDI Enrollment Agreement
  • Online Inquiry Services (DDE for HHH)
  • Provider Authorization Form if using a Billing Service
On the left you will see the forms under "Attachments"

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 prior to initiation of electronic claims submission. 1. EDI Enrollment Packet If the link listed above does not work properly, please download this form from: http://www.cgsmedicare.com/parta/edi/index.html Click on "EDI Enrollment Packet" If you have any questions regarding any of the documents in this package, please call the CGS EDI Technology Support Center at 1-866-520-4022.

Required Information

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 MVP office before the initiation of electronic claims submission or inquiry. 1. MVP Health Care EDI Enrollment Form If the link listed above does not work properly, please download the form here, entitled EDI Enrollment Form under EDI Forms and Guides: www.mvphealthcare.com

Required Information

Enrollment Instructions

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

Enrolling for a Submitter ID

To enroll for a Submitter ID with VT Blue Cross Blue Shield please call 1-800-334-3441 or email them at editechsupport@bcbsvt.com In the email/call you must let them know your monthly claim volume and they will determine if it is large enough to allow for a direct connection. If not, you will need to submit through a clearinghouse and would be able to go through Availity using SolAce EMC. If a Direct connection is allowed, you will need to complete the following forms: 1. EDI Enrollment Form

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI). Please Note: Before Harvard Pilgrim will assign you a Direct Submitter ID, you must contact them to verify if your claim volume is sufficient for a direct connection. Otherwise, you may be required to submit your claims via a clearinghouse. To verify the claim volume requirement, please call the Harvard Pilgrim EDI Technology Support Center at 1-617-509-8861.

Required Documents, If Harvard Pilgrim allows you to Submit Direct

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

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI). In order to begin filing claims electronically you must first be actively enrolled with Virginia Medicaid.

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 Virginia Medicaid ACS office prior to initiation of electronic claims submission or inquiry Please complete the following forms: 1. Electronic Claims Submission Enrollment Packet

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 Highmark office prior to initiation of electronic claims submission or inquiry. 1. 5010 EDI Transaction Application to Create New Trading Partner If the above link does not work properly, follow these steps: To apply for a Highmark Blue Shield Submitter ID please go to the following site: www.highmark.com/edi -Click on Sign Up Under the Related Links Section:

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 DHHS office prior to initiation of electronic claims submission or inquiry. 1. Trading Partner Agreement 2. Electronic Claims Submission IF the above links do not work properly, please download them from the website:

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