Use the EDI E-Mail Inquiry Form to request a restore of your remit file. There is a 45 calendar day window for available remittances. Please include the date of the remit, amount, PTAN and NPI. Do not include tax identification number or PHI/PII.
ERAs are available in your mailbox for 45 calendar days.
Use the EDI E-Mail Inquiry Form to request a restore of your remit file. There is a 45 calendar day window for available remittances. Please include the date of the remit, amount, PTAN and NPI. Do not include tax identification number or PHI/PII.
An entirely new EDI Enrollment form must be submitted. Please refer to the EDI Guided User Enrollment Guide for instructions on completing the Enrollment form.
Verify EDI Enrollment through the EDI Enrollment Search. The information required for the tool is Contractor, NPI, PTAN and Request Date or your Packet ID.
A 277CA (Claim Acknowledgement) report will indicate if your claims are accepted into the Part A or Part B claims processing system, or if your claims were rejected. There will be no further reporting on your claim file after receipt of the 277CA report.
The STC segment will include the health care claim status codes. Utilize the EDI Front End Edit Rejection Lookup Tool for the description of the codes.
Yes. The 277CA (Claim Acknowledgement) report is received when testing with NGS EDI.
The group PTAN (provider number) and group NPI must be submitted on all EDI enrollment forms when a provider is a member of a group. If a provider is a member of a group, only one agreement is required.
Whenever an enrollment form asks for an ‘Entity Name’ please make sure this matches what is on the 855 enrollment form or PECOS. Also, please make sure the address listed for the provider matches the address on file with Medicare. Please submit your request using the provider's physical address. If there has been a change to the location of the provider, it must be submitted and approved on the 855 application prior to submitting it on the EDI requests.
Please have the following information available prior to calling about an EDI-related issue so we may assist you:
- PTAN, also known as a provider number, or your NPI
- Company name
- Contact name
- Telephone number
- City and state
- Submitter ID
- Claim File Name or ID
- Error Message
National Government Services requires connectivity to the EDI Gateway for exchange of EDI data through select NSVs. In addition to connectivity to the EDI Gateway for the exchange of HIPAA transactions, these vendors offer services and benefits which include:
- Access to the FISS/DDE Provider Online System (for Medicare Part A providers)
- Access to the CMS HETS application for eligibility inquiry and response.
Detailed information regarding NSVs can be found on the EDI Solutions page of the NGS EDI website.
An approved entity is a software vendor or clearinghouse billing service that has tested and passed the current 5010x12 format. This means that their software is HIPAA compliant. The list of Approved Entities is located on the EDI Solutions page of the NGS EDI website. If a software is not listed, they must contact EDI Enrollment for testing.
The address on the EDI enrollment forms must match the address that was submitted to our provider enrollment department when enrolling for a provider number. If the address on the completed EDI enrollment form does not match, your entire EDI enrollment packet will be rejected.
Every provider who authorizes a billing service and/or clearinghouse to act on their behalf must complete the provider authorization form. This form must be completed by the provider and submitted with the EDI application.
NGS EDI will reject claims with a P.O. Box in the billing provider address.
The STC segment will include the health care claim status codes. Utilize the EDI Front End Edit Rejection Lookup Tool for the description of the codes.
For Medicare claims, yes. For commercial insurance, no.
For any questions regarding CSCs and EIC codes on the 277CA, please utilize the EDI Front End Edit Rejection Lookup Tool for the description of the codes. Under the description will be the reason for the error. Please correct accordingly.
National Government Services returns back to the submitter, in this case the clearinghouse, a 999 report. If the 999 report was accepted a 277CA report is generated and sent to the submitter. The 277CA report will include ICN/DCN for accepted claims. Please contact your clearinghouse if you are not receiving these acknowledgement/acceptance reports in a readable format.
National Government Services EDI will reject claims with a P.O. Box in the billing provider address.