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). 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). 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).

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 Novitas Solutions office prior to initiation of electronic claims submission or inquiry. You must copy and paste the links below into your web browser’s address bar in order for them to work properly. 1. Novitas Solutions EDI Enrollment Form (8292JH)

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 Novitas Solutions office prior to initiation of electronic claims submission or inquiry. You must copy and paste the links below into your web browser’s address bar in order for them to work properly. 1. Novitas Solutions EDI Enrollment Form (8292JH)

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 Trailblazers office prior to initiation of electronic claims submission or inquiry. 1. EDI Enrollment Packet To download the ERA request forms go to the following links: Medicare Part A Electronic Remittance Advice (ERA) 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 Novitas Solutions office prior to initiation of electronic claims submission or inquiry. You may need to copy and paste the links below into your web browser’s address bar in order for them to work properly. 1. Novitas Solutions EDI Enrollment Form (8292) 2. Novitas Solutions Vendor Agreement Form (8291) (For Billing Services Only)

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