EDI E-Signature User Guide

Entry Process Questions

  1. I need to complete a Logon Request Form

    This option is used for a provider/facility to request/modify access to the Part A FISS/DDE system. (EDI Enrollment Agreement is included within this packet if needed.)
     
  2. I need to complete a Registration Form. (EDI Registration Form includes all EDI Part A and Part B scenarios such as claims and remits.)

    This option is used to either obtain/update a Trading Partner ID or for provider/facility to request/modify batch transactions for a direct biller or through a third party billing service or clearinghouse. (EDI Enrollment and ERA Enrollment Agreements are included within this packet if needed.)
  1. What is the Method of Electronic Submission? Choose billing Service, Clearinghouse or Direct Biller from the drop down menu. These are the three options to exchange batch transactions with EDI.
  2. What do I select in the Approved Entities List? This option will only appear if Clearinghouse or Direct Biller is chosen in the Method of Electronic Submission. Within the drop down, select the approved vendor or clearinghouse being used for Claim submission. If you do not see the company listed, select other and complete the required fields.
  3. What information should I put in the Contact Information fields? For a Direct Biller, enter the First and Last name of the employee within the Software Vendor company who would be responsible for questions regarding EDI transactions.
  4. What information should I put in the Clearinghouse or Billing Service Contact Name fields? First and Last Name of an employee within the clearinghouse or billing service who would be responsible for questions regarding EDI transactions.
  5. What information should I use in the Email Address field? An email address that can be used to contact the clearinghouse or billing service. (If you will not be using a clearinghouse or billing service, this field is not required.)
  6. What do I enter for Vendor Information? These fields are only required when selecting “Other” within the Approved Entities List or Billing Service as the Method of Electronic Submission. Enter the name, address, city, state, ZIP code, and telephone number for the billing service or software company who is creating or exchanging transactions with EDI.
  1. I am a provider who only needs to fill out an EDI Enrollment Agreement

    This option is used for a Provider/Facility who does not yet have an EDI Enrollment Agreement form on file with NGS. (No other forms will be presented within this packet.)
     
  2. I am a provider who needs to complete a Part A Logon Request Form Letter of Authorization

    This option is used for a provider/facility to authorize a billing service’s access to the Part A FISS/DDE system to perform billing functions on their behalf. (EDI Enrollment Agreement is included within this packet if needed.)

    1. What information should I put in the Provider Information fields? First and last name of the employee within the provider/facility’s office who would be responsible for questions regarding FISS/DDE access, permissions, etc.
    2. What information should I use in the Email Address field? An email address that can be used to contact the employee within the provider/facility’s office who would be responsible for questions regarding FISS/DDE access and the annual logon recertification.
  1. I am a billing service that needs to complete a Part A Logon Request Form. (I have a Letter of Authorization PIN.)

    This option is used for a billing service that was given a Letter of Authorization PIN number by the Provider/Facility who is authorizing FISS/DDE access to perform billing on their behalf.

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