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 PGBA office prior to initiation of electronic claims submission or inquiry. 1. Clearinghouse/Direct Submitter Trading Partner Agreement (Fill out this form if you will be sending claims directly to Tricare) http://www.mytricare.com/Internet/tric/tri/imglib.nsf/(WebFiles)/F0016397A84B8BC285257A0200683907/$FILE/Clearinghouse%20Direct%20Submitter%20Trading%20Partner%20Agreement%20Revised%2004%202012.pdf

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI). In order to bill claims electronically to the American Specialty Health ASHLink network, providers must call 1-800-972-4226 and request a User ID, Password and Pin for the ASHLink Clearinghouse. Once you receive your log in information for www.ashlink.com you must do the following:

• Login to your account
• Click Batch Claims at the top and complete the Questionnaire
  • For your Practice Management System, choose Other and enter SolAce
  • Yes SolAce is able to submit batch claims
  • Choose both on the question asking how you currently submit claims
  • Choose Yes to receive more information about testing for batch claims with ASH

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 First Coast office prior to initiation of electronic claims submission or inquiry. 1. EDI Enrollment Form with Instructions 2. Electronic Data Request (EDR) Form To obtain the forms above, please copy the link below into a new tab or browser, and select your state and line of business: http://medicare.fcso.com/EDI_Forms/ If you have any questions regarding any of the documents in this package, please call First Coast EDI Technology Support Center at 1-888-670-0940, option 4.

Enrollment Instructions

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

Instructions on Enrolling for a Submitter ID

• To enroll for a Submitter ID with WA Blue Cross: Premera please follow the instructions below:
  • Call 1-800-435-2715, select option 1 and let the EDI Representative you speak to know that you would like for them to fax or email you an Enrollment Packet for electronic claims submission. If you would like to receive your EOBs electronically in SolAce please also let them know that you would also like for them to send you the form for Electronic Remittance Advices. If they ask if you will be receiving the Advices Directly please say “Yes”

Enrollment Instructions

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

Note: This is for Participating Providers Only

To Enroll for a Submitter ID with GuildNet for direct submission of 837P and/or 837I files through PCS, please email their Provider Relations Department at PCS_ProviderRelations@lighthouseguild.org. In the body of your e-mail let them know you are interested in applying for a Submitter ID so you can send your electronic claims directly to them.

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI). To enroll for a submitter ID with Colorado Access please contact their EDI Operations Team at 720-744-5172 and ask to speak to Jennifer Hutchings. Let her know you are interested in applying for a Submitter ID so you can send your electronic claims directly to them.

• Give her the following information:
  • You will be a direct submitter
  • You need an SFTP Connection
  • You are NOT using a Clearinghouse
  • You are either sending 837P, Professional and/or 837I, Institutional Claims
  • You are able to receive electronic 835 files (Remittance Advice), when they are capable of sending them.