- 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
Submitting the Packet
Once the General Enrollment Information section is complete and submitted, the necessary enrollment forms will be presented. All information previously answered will be auto-populated on each individual EDI form. You will need to complete the following on each form to submit the enrollment packet:
- Verify all fields display the correct information on each form.
- Complete all remaining fields (see Additional Information about Forms).
- Read the Terms and Conditions on each form, using the check boxes for each if you agree.
- Have the authorized or delegated official on file with PECOS enter their name in the Authorized Official Name field and their employment title in the Authorized Official Title field on each form. The authorized or delegated official’s name entered will be verified against the PECOS system by EDI Enrollment. These are the only signatures that will be accepted on the EDI forms with exception to a third party requesting a new Trading Partner ID.
- Select the Electronically Sign button on each form.
Note: The enrollment packet will not be faxed to EDI for processing.
After the enrollment packet is submitted, a confirmation message is displayed on the screen with the assigned Packet ID (PID) number. This has completed the submission process. You will be given the options to Print this Packet, Finish and Exit, or Start New Packet.
- Print this Packet – This would be for your own reference and the only opportunity to print the packet. The packet is not faxed to EDI for processing.
- Finish and Exit – This will return you to the EDI home page
- Start New Packet – If you wish to submit more than one enrollment packet, this will return you to the beginning of the Guided Enrollment process to enter information for your new packet.
The PID for your submitted packet will be emailed to the email address entered on the enrollment packet.