- Entry Process Questions
- General Information
- Choose Transaction Status
- Submitting the Packet
- EDI Enrollment Agreement Form
- EDI ERA Enrollment Form
- EDI Registration Form
- Part A Logon Request Form: Provider/Facility Requesting Access
- Provider Letter of Authorization
- Part A Logon Request Form: Billing Service Using a Letter of Authorization PIN
- Tracking my Enrollment Packet and Checking Status
- EDI Gateway Self-Service Password Portal
General Information
If information entered belongs to a Corporate Office, select the “Corporate Office” checkbox.
- What is the Entity Name?
This is the provider name that was submitted on the CMS-855 form when applying to participate with Medicare.
- What information should be put in the fields for Street Address, City, State, ZIP, Telephone Number, and Telephone Number Extension?
This is the provider’s information; physical location/business address and contact phone numbers where the entity can be contacted upon completing the processing of the request.
- Who should I put for the Contact First Name, Contact Last Name, and Title fields?
This is the person who would be contacted regarding questions related to the enrollment packet and would be authorized to receive information sent by the EDI Enrollment team. The person’s employment title at the company is placed in the title field.
- What email address should I put in the Email field?
The email address entered in this field will be used by EDI Enrollment to send communication regarding the enrollment packet. Please be sure to use an email address that is frequently checked and add ngs.edi.setups@anthem.com as an accepted email.
- What is the Contractor Code?
The Contractor Code is a five-digit numeric code that indicates your MAC, also known as the Carrier Code or Payer ID.
If address information is the same as entered above, select the “Address is the same as above” checkbox.
- What is primary PTAN?
Provider number assigned to the Medicare provider during the provider enrollment process from the CMS-855 forms. This number would be on the Welcome to Medicare letter you received confirming enrollment into the Medicare system. Note: If your PTAN contains alpha characters, they must be entered in upper case.
- What is primary NPI?
The NPI is a unique 10-digit identification number for covered healthcare providers.
- What is Show Additional PTAN/NPI?
This allows you to add 25 PTAN/NPI combinations along with address information for each entry.