I Am a Billing Service and “I Want to Use a Provider's PIN From their Letter of Authorization (LOA)”

This selection will prompt you to complete the Logon Request with PIN Form.

This objective is for a third party who wishes to request, modify, or add additional access to the Part A FISS/DDE system on behalf of the provider using the provider supplied Letter of Authorization PIN.

Step 1. Letter of Authorization (LOA) PIN

Enter the LOA PIN in the “PIN” field as shown below:

 
Next, click the “Check” button to verify the LOA PIN as shown below:

Once verified, in the lower right-hand corner the section will be marked as complete, and you may proceed by clicking the “Next” button.

Step 2. Billing Information

Complete the following fields as it applies to the billing service:

• Billing Service Name - Enter the billing service name
• Billing Service Address - Enter the billing services physical or corporate address.
• Primary contact First and Last Name - Enter the first name of the contact within the billing service office that will be the authorized contact.
• Title - Enter the title of the contact person authorized for the billing service.
• Email Address - Enter the email address of the authorized contact for the billing service.
• Telephone Number - Enter the billing service’s direct telephone number.

Step 3. PTAN/NPI Information

The fields in this section will be auto populated based on the LOA PIN that was verified in step one of the guided process.

Step 4. Operators List

This section is completed with the operator’s information.

If there is one Operator Request the select the applicable action type for the request from the “Action” drop-down box.

Any additional action types for the same Operator will require an additional form to be completed.
Actions provided in the drop-down box:

• Add PTAN(s) - Add PTAN(s) to an ID that currently has access to the FISS region the PTAN(s) are assigned to.
• Change Operator Access - Update access level; either Inquiry or Inquiry/Update can be selected
• Add Region (Dual Access) - Add an additional region of FISS access to an ID that is currently active
• Delete Logon ID - Delete all current access to Medicare FISS regions, PTAN(s), inactivate the Logon ID.
• Delete PTAN(s) - Delete only specific PTAN(s), while leaving the Logon ID active. 
• Name Update - Update username based on marriage, divorce, etc.; cannot change name to a new user.
• New Logon ID - Assign a new user a Logon ID (previously assigned inactive Logon IDs will need to be reinstated).
• Reinstate Logon ID - User has an existing Logon ID that is currently inactive.
• Change PIN - JM users only; user has the ability to change the four-digit numeric PIN currently on file.
• Update Contact - Update the Authorized contact on file.

Note: If the user has access to multiple contract codes, only the contract code selected on the form will be deleted from their access. If the user only has access to the contract code selected on the form, the ID will be deleted entirely.

Note: Only fields specific to the action selected will display.

• Operator First and Last Name - Enter the first name, middle initial and last name of the operator who will be accessing the FISS/DDE system.
  • Note: The middle initial is not a required field. If entering the middle initial, do not use X for the middle initial unless it actually is the middle initial.&
• Telephone Number/Extension - Enter the direct telephone number and extension of the user
• Email - Enter the direct email address of the user.
• Logon ID - This is the seven-digit Logon ID assigned to the user.
  • two alpha, five numeric (XX11111) or – three alpha, four numeric (XXX1111)
• Operator Access – Choose either Inquiry or Inquiry/Update from the drop-down
  • “Inquiry” gives the ability to check status but not make changes.
  • “Inquiry/Update” gives the user the ability to check eligibility and make changes, such as sending or correcting a claim.

If there’s multiple Operators to include, then select “I have multiple Operator Requests”.

• You can add up to 25 operators who are requesting the same access per form
• You must download and complete the supplied template.
• Once completed you must upload the template.

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.

Next, select billing service from the “Operating as” a 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).

Step 6. 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.

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.