I Am a Provider and “I Want to Complete an EDI Registration Form”

This selection will prompt you to complete the EDI Registration Form.

This option is for providers who wish to submit claim files using a third party such as a billing service or clearinghouse, obtain a new Trading partner ID to submit claim files directly to Medicare, or update their existing Trading Partner ID used to submit claim files directly to Medicare.

Step 1. Provider Information

• Complete the following fields as it applies to the provider of services:
• Provider/Facility Name - Enter the name EXACTLY as it was approved in section 2 of the CMS-855/PECOS enrollment applications.
• Provider/Facility Address – Enter the physical or corporate address EXACTLY as approved in section 4 of the CMS-855/PECOS enrollment application.
• Contact First and Last Name – Enter the name of the contact within the provider’s office that will be the authorized contact for any logon IDs requested.
• Title – Enter the title of the contact person within the provider’s office.
• Email Address – Enter the email address of the authorized contact for the provider/facility.
• Telephone Number – Enter the provider/facility telephone number to their office.

Step 2. What Transactions will you Authorize for this Submitter?

Select all the EDI Electronic Transactions you are authorizing for the submitter will be exchanging.

Be sure these are transactions that your Clearinghouse has been approved to exchange.

If you are a new provider, it is required to have 837 claims established in order to obtain 835 remits.

Note for Part B providers: For more information please view the NGS Standard Companion Guides

Step 3. PTAN/NPI Information

If there is one PTAN/NPI complete the following fields as it applies to the provider of services in the PTAN/NPI Information section:

• Primary PTAN - Enter the provider’s primary PTAN.
• Primary NPI - Enter the provider’s primary NPI.
• Provider/Facility Name - Enter the name EXACTLY as it was approved in section 2 of the CMS-855/PECOS enrollment application.
• Provider/Facility Address - Enter the physical or corporate address as approved in section 4 of the CMS-855/PECOS enrollment application.
  • If this is the same information entered in the “Provider Information” section check the box at the top of this section “Address is same as listed above”.
  • If the provider/facility office location is not the same as their corporate or primary location enter the provider/facility’s secondary location address EXACTLY as approved in section 4 of the CMS-855/PECOS Enrollment Application.

If there’s multiple PTAN/NPI numbers to include, then select “I have multiple PTAN/NPIs” tab.

• You can enter up to 100 PTAN/NPI combinations.
• They must all be for the same Medicare Contractor Code.
• They must all have the same Authorized or Delegated official.
• You must download and complete the supplied template.
• Once completed you must upload the template.

Step 4. Trading Partner Information

Select the approved action from the drop-down box.

This section is used to determine the necessary action taken for the PTAN(s) entered.

• Obtain TPID - Obtain a new Trading Partner ID for an entity.
  • Note: TP IDs are contractor code specific.
  • Note: A Software Vendor will need to be selected from the dropdown.
• Update TPID - Update an active Trading Partner ID currently on file with National Government Services (add PTAN(s), transaction types, software vendors, etc.).
  • Note: Making updates to a TP ID can only be authorized by the owner of the ID.
  • Note: A Software Vendor will need to be selected from the dropdown.
• Link to Third Party - Providers allowing a billing service and/or clearinghouse to exchange transactions with NGS on their behalf.
• Submitter type - this field will auto-populate based on what is selected within the guided enrollment.

What is a Software Vendor?

The approved Software Vendor that supplies the necessary software to bill electronically (only required when the action Obtain or Update TPID is selected in Section I). To find a Software Vendor, visit our Approved Entities List and filter by software vendor and your line of business.

Step 5. Operating Information

Select the Network Service Vendor that will be providing your connectivity to National Government Services in the Network Service Vendor drop-down box.

What is a Network Service Vendor?

The approved NSV that provides access to the National Government Services EDI gateway that you have a service agreement with (only required when the action Obtain or Update TPID is selected in Section I). The approved Network Service Vendors are located on our website.

Step 6. Offshore Provider Information

Select “Yes” or “No” to indicate whether you or your organization uses one or more business entities that work outside the United States or US Territories to access the NGSConnex Provider Portal.

If “Yes” is selected complete the additional questions/information:

Step 7. Authorized Signature

Review the Terms and Conditions and check the box “I agree to the terms and conditions above”.

• Be sure to note, the requirements for who may sign the documents. Signature must be an EXACT match as approved in section 5/6 of the CMS-855/PECOS Enrollment Application

Next, scroll down and complete the “signature name” and “title” fields and click the “Submit” button.

Once completed, the EDI Enrollment Complete screen will display.

This screen will provide the PID information. You will also have the option to print the packet, finish and exit, or start a new packet. With printing, you are able to print to PDF which will allow you to save a copy of the packet or select the appropriate printer to obtain a paper copy.

Revised 10/18/2023