- General Information
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Submitter Type - Provider
- Submitter Type - Provider
- I Am a Provider and “I Want to Connect Directly to the Part A FISS/DDE System”
- I Am a Provider and “I Want to Allow a 3rd Party Billing Service to Bill for Me Using the Part A FISS DDE System”
- I Am a Provider and “I Want to Complete an EDI Registration Form”
- I Am a Provider and “I Want to Complete a Connex Registration Form”
- Submitter Type - Billing Service
- Submitter Type - Clearinghouse
Common Questions
- What is the Entity Name?
This is the EXACT provider’s name that was submitted in section 2 of the CMS-855/PECOS enrollment application when applying to participate with Medicare.
- What information should be put in the fields for Street Address, City, State, ZIP, Telephone Number, and Telephone Number Extension?
The address must be an EXACT match of the physical practice address on file in section 4 of the CMS-855/PECOS enrollment application. This may include suite/apartment, direction or street/road designation. This is not an inclusive list. If there has been a change to the location of the provider, it must be submitted and approved on the CMS-855/PECOS application prior to submitting it on any EDI Requests.
- Who should I put for the Contact First Name, Contact Last Name, and Title fields?
This is the person who would be contacted regarding questions related to the enrollment packet and would be authorized to receive information sent by the EDI Enrollment team. The person’s employment title at the company is placed in the title field.
- What email address should I put in the email field?
The email address entered in this field will be used by EDI Enrollment to send communication regarding the enrollment packet. Please be sure to use an email address that is frequently checked and add ngs.edi.setups@anthem.com as an accepted email.
- What is the Contractor Code?
The Contractor Code is a five-digit numeric code that indicates your MAC, also known as the Carrier Code or Payer ID.
If address information is the same as entered above, select the “Address is the same as above” checkbox.
- What is primary PTAN?
Provider number assigned to the Medicare provider during the provider enrollment process from the CMS-855 forms. This number would be on the Welcome to Medicare letter you received confirming enrollment into the Medicare system. Note: If your PTAN contains alpha characters, they must be entered in upper case.
- What is primary NPI?
The NPI is a unique 10-digit identification number for covered healthcare providers.
- What is the Billing Service Name?
This is the official name of the billing service that you have contracted with to perform DDE functions on your behalf.
Revised 10/18/2023