How to get into EDI enrollment

Carriers, MACs, and FIs are required to furnish new providers that request Medicare claim privileges information on EDI. DME MACs are to furnish such information to new providers when contacted by providers, or by the National Supplier Clearinghouse identify new suppliers that have been issued new identifers. Carriers and FI are required to assess the capability of entities to submit the data electronically, estabilish their qualifications (see test requirements in §50), and enroll and assign submitter EDI identification numbers to those approved to use EDI.

When providers contact a contractor to submit/receive transactions electronically using a billing agent or a clearinghouse/network services vendor, carriers, MACs or FIs must notify those providers that they are required to have an agreement signed by that third party in which the third party has agreed to meet the same Medicare security and prequirements that apply to the provider in regard to viewing or use of Medicare beneficiary data. (These agreements are not to be submitted to Medicare, but are to be retained by the providers.) The providers must also be informed that they are not permitted to share their personal EDI access number and password with any billing agent,clearinghouse/network service vendor; to anyone on their own staff who does not need to see the data for completion of a valid electronic claim, to process a remittance advice for a claim, to verify beneficiary eligibility, or to determine the status of a claim; and that no other non-staff individuals or entities may be permitted to use a provider’s EDI number and password to access Medicare system. Clearinghouse and third party entity representatives must obtain and use their own unique EDI access number and password from those Medicare contractors to whom they will send or from whom they will receive EDI transactions.

A provider must obtain an NPI and furnish that NPI to their Medicare contractor prior to completion of an initial EDI Enrollment Agreement and issuance of an initial EDI number and password by that contractor. The Medicare contractor is not required tverify that NPI in the NPI Crosswalk or another location with the understanding that ithe provider attempts to use an incorrect NPI, the provider’s claims will reject. It would be counterproductive for a provider to furnish an incorrect NPI at the time of EDI enrollment. A provider’s EDI number and password serve as a provider’s electronic signature and the provider would be liable if any entity with which the provider improperly shared the ID and password performed an illegal action while using that ID and password. A provider's EDI access number and password are not part of the capital property of the provider's operation.and may not given to a new owner of the provider’s operation. A new owner must obtain their own EDI access number and password.

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