I Am a Billing Service and “I Want to Connect Directly to the Part A FISS/DDE System”

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

This option is for a third party who wishes to update an operator's contact information, change an operator's name, change the operators access or delete a Logon ID.

Step 1. Billing Service 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 service’s physical or corporate address.
Primary contact First and Last Name - Enter the 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.

Billing Services Information fields

Step 2. 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:

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.
Change Name - Update username based on marriage, divorce, etc.; cannot change name to a new user.
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.

Operators List page.

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”.

I have multiple operator requests, on the operators list page.

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 3. 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.

The “Operating as” field will auto-populate.

Operating Information fields.

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 4. 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.

Authorized Signature page.

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.

EDI Enrollment Complete display.