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  • Posting Date: 07/22/2016
    EDI Registration Form

    EDI Registration Form This form is used for batch billing enrollment: Part A/B providers who submit batch transactions to Medicare, such as transmitting 837 claims, receiving 835 electronic remittances and requesting 276/277 claims status [...]

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  • Posting Date: 07/22/2016
    Part A Logon Request Form: Billing Service Using a Letter of Authorization PIN

    Part A Logon Request Form  Billing Service Using a Letter of Authorization PIN This option allows a billing service to complete the Part A Logon Request Form after the Letter of Authorization has been completed by the provider/facility [...]

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  • Posting Date: 07/22/2016
    Entry Process Questions

    Entry Process Questions 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.) [...]

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  • Posting Date: 07/22/2016
    EDI ERA Enrollment Form

    EDI ERA Enrollment Form The EDI ERA Enrollment Form is required to be on file for each PTAN/NPI currently setup or requesting to be setup for the first time to receive electronic remittances through NGS. Should I Complete This Form? The [...]

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