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 NGS office prior to initiation of electronic claims submission or inquiry. 1. EDI Enrollment Form 2. EDI Submitter Action Request Form 3. EDI Third Party Form

Enrollment Instructions

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

Required Process for those applying for new Submitter IDs

Please go to the following link to complete WPS' online Registration Form https://corp-ws.wpsic.com/apps/wtps-web/unauth/RegistrationLoadAction.do
  • Enter your Business or Provider Name in the Submitter Name field
  • Enter your Demographic & Contact Information
  • For To and From Transmission Method, select WGBBS
  • Check the following boxes:
    • Receive Acknowledgement
    • Receive Remittance (If you would like to receive electronic EOB's)
  • For Vendor Name enter: AXIOM Systems, Inc. (formerly Ivertex)
  • Click Save

Enrollment Instructions

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

Required Process for those applying for new Submitter IDs

To enroll for a submitter ID with Illinois Medicaid please follow the instructions below.
  • Go to http://www.myhfs.illinois.gov
  • Click on Register on the left
  • Press the button labeled “Illinois Accept”
  • Fill out your information on the online form
  • When asked which transactions you wish to be setup with select:
    • 837 I for Institutional Claims
    • 837P for Professional Claims
    • 835 for Remittance Advice
  • If you need help with this process: Go to the “New Users’ section.

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI). To enroll for a Submitter ID with Independent Health please contact their EDI Operations Team at 716-635-3911. Let them know you are interested in applying for a Submitter ID so that you may send your electronic claims directly to them.
  • Let them know your billing software is called SolAce EMC by AXIOM Systems Inc., formerly Ivertex and that we are already approved as one of their software vendors.
  • Ask them if they can send you the form(s) required to obtain your Submitter ID so you can submit electronic claims directly to them.
  • You may also email them at e-commerce@independenthealth.com

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 Palmetto GBA office prior to initiation of electronic claims submission or inquiry. 1. EDI Application Form 2. Medicare Electronic Data Interchange Enrollment Agreement 3. Provider Authorization Form (For Billing Services Only) To obtain the forms above, please download them from:

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI). To apply for a submitter ID and password for OMAP please go to: http://www.dpw.state.pa.us/provider/promise/certification/certificationinfoforansix21v5010ncpdpinteractived.0orbatch1.2/index.htm
  • Scroll Down to the very bottom and click on the link that says: “PROMISe Transaction Certification Registration Form”.
If you have any questions regarding any of the documents in this package, please Call the OMAP EDI Technology Support Center at 1-800-248-2152.

Required Information

We recommend that you have the following information ready before filling out your forms:

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI)
  • To apply for an AR Medicaid electronic Submitter ID, please go to the following website and click on the link for "New Submitter Registration Form"
    • https://www.medicaid.state.ar.us/InternetSolution/provider/hipaa/regis.aspx
Billing Services and Providers
  • Select "Provider" if you are Provider. If you are a Billing Service, select "Vendor"
  • Complete the "Submitter" section with your demographic and contact information
  • Select and Answer 5 Security Questions then click Next
  • Enter the PIN numbers of the Providers you will be billing for and click Add

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI). All providers must first register for Noridian’s Total Onboarding System in order to become an electronic submitter. Guides can be found at http://www.edissweb.com/cgp/forms/onboard.html Once you have established your Total On Boarding Account, please log into your account.
  • On the first page, click the “Manage NPIs” button and choose your billing NPI.
  • Select the transaction types you want to enroll your Billing NPI for:
    • For Professional claims, click “Enroll” for 837P (5010A1)
    • For Institutional claims, click “Enroll” for 837I (5010A1)
    • To receive your EOBs electronically, click “Enroll” for 835 (5010A1)

Enrollment Instructions

Thank you for your interest in Electronic Data Interchange (EDI). In order to be able to submit claims electronically to AK Blue Cross Blue Shield, you must first go to onehealthport.com and Register for an OHP User ID (if you do not have one). You may click on this link to launch the One Health Port Registration Page: http://www.onehealthport.com/register/index.php Once you receive your OHP User ID, you will then be able to access the forms below from your OHP account.

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.

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 VT Medicaid office prior to initiation of electronic claims submission or inquiry. 1. EDI Registration Form 2. Trading Partner Agreement If the links listed above do not work properly, please download them from: http://www.vtmedicaid.com/Downloads/tools.html

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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.

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