Submission of EDI Enrollment Forms

We’ve added validation within the EDI Enrollment Form submission process that will verify provider information as the form is being completed. Previously, this validation was completed after submission, and invalid/inaccurate entries resulted in rejected submission.

This validation will check the Legal Business Name, Physical Practice Location and/or Signature of the Authorized/Delegated Official. If the information is not correct, submission will not be allowed.

Tips to prevent/resolve these validations:

• Legal Business Name: The Legal Business Name must be an exact match to how it was enrolled with Medicare, including Business Type (LLC, Corp, Inc) if applicable. Verify this in PECOS by navigating to “My Associates”, “View Enrollment”, then “View Approved Enrollment Record”. Scroll to “Personal/Business Information”.
• Physical Practice Location: The address must be an exact match of the physical practice location enrolled with Medicare. This may include suite/apartment, direction or street/road designation. Verify this in PECOS by navigating to “My Associates”, “View Enrollment”, then “View Approved Enrollment Record”. Scroll to “Physical Location.”
• Authorized/Delegated Official Signature:
  • For a Sole Proprietor: The signature of the provider must be an exact match to how it was enrolled in Medicare. This can include things such as a middle name/initial and suffixes. Verify this information in PECOS by navigating to “My Associates”. Scroll to the legal name and select “View Enrollment” to the right of the name. Scroll under the existing enrollment to the enrollment box for the PTAN and select “View Approved Enrollment Record.” Scroll to Section 2: Personal Identifying Information.
  • For a Business: The signature of the Authorized/Delegated Official must be an exact match to how it was enrolled in Medicare. This can include things such as a middle name/initial and suffixes. Verify this information in PECOS by navigating to “My Associates”. Scroll to the legal name and select “View Enrollment” to the right of the name. Scroll under the existing enrollment to the enrollment box for the PTAN and select “View Approved Enrollment Record”. Scroll to Section 6: Ownership and/or Managing Control.

Posted 4/5/2024