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�� &#x/Att;¬he; [/;ott;&#xom ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;&#x/Att;¬he; [/;ott;&#xom ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;HeW CEDI Enrollment InstructionsPage Please PRINT THESE INSTRUCTIONAL PAGES to assist you with completing the correct information. When you click on the link below, you will be redirected to the CEDI website. Once you are on this CEDI page, select Start Enrollment Process under Step 3 of the following web . Click Here To Access the Enrollment Stepshttps://enroll.ngscedi.com/cedienrollment You will need to accept the Attestation. HeW’s Trading Partner ID for Health-e-Web is D08607099 05655 CEDI All DMERC Regions EDI ENROLLMENT �� &#x/Att;¬he; [/;ott;&#xom ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;&#x/Att;¬he; [/;ott;&#xom ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;HeW CEDI Enrollment InstructionsPage Please also see the following CEDI instructions. HeW Information You May Need Adding to an EXISTING SUBMITTER Submitter Name : HEALTH - E - WEB Submitter Type : CLEARINGHOUSE Submitter ID / Trading Partner ID : D08607099 Street: 2525 Colonial Drive Suite A City: H elena State: MT Zip: 59624 Contact Name: Enrollment Support Group Phone: 877 - 565 - 5457 E - mail Address: Hewenrollment@availity.com Last Revision: January 21, 2016 Page of ��Common Electronic Data Interchange Guided Enrollment ProcessGuided Enrollment Process Table of Contents General InformationWhat is the Supplier Name?What information should be put in the fields for Street Address, City, State, ZIP,

2 Telephone Number, and Telephone Number
Telephone Number, and Telephone Number Extension?What is the Trading Partner ID?Who should I put for the Contact First Name, Contact Last Name, and Title fields?What e-mail address should I put in the Email field?What is the NPI number?What is the PTAN?How do I add additional NPIs and PTANs?What transaction types are available?Enrollment Information10.Which transactions should I select? Method of Electronic Submission11.What should I select for “Please select the method you will be using to submit yourElectronic Transactions”? 12.What clearinghouse/billing service or software vendor will you be using? Submitting the PacketAdditional Information about FormsCEDI Trading Partner Action Request Form13.What should be selected for the question “Are you a Clearinghouse or Third PartyService?” 14.What should be selected for the question “Are you a Vendor?” 15.What should I select for the Network Service Vendor drop down box? CEDI Enrollment Agreement Form16.What should I put for Trading Partner Name? CEDI ERA Enrollment Form17.What information should I use in the Provider Identifiers fields? 18.What is Preference for Aggregation of Remittance Data (e.g., Account Number Linkage toProvider Identifier)? 19.What is the Requested ERA Effective Date? Tracking My Enrollment Packet and Checking StatusCEDI Gateway Self-Service Password Portal ��Common Electronic Data Interchange Guided Enrollment Process Last Revision: January 21, 2016 Page of General Information What is the Supplier NameThe supplier name must be entered as it is listed on file with the National SupplierClearinghouse (NSC). CEDI forms will be rejected containing a name that does notmatch. Contact the NSC to verify this information at 866- or visit their Website at http://www.palmettogba.com/nsc for more information. What information should b

3 e put in the fields for Street Address,
e put in the fields for Street Address, City, State,Telephone Number, and Telephone Number ExtensionThis is the physical location/business address and contact phone numbers where theSupplier can be contacted upon completing the processing of the request.What is the Trading Partner IDA Trading Partner ID is assigned by CEDI and is used to log in and exchange electronictransactions (e.g., 837 claims, 835 ERAs, 276/277 claims status and responses, orNCPDP claims) with CEDI. This is also referred to as a Submitter ID. Leave blank if you are requesting a new Trading Partner ID. Note: If you use a clearinghouse or third party biller, they will provide you with theTrading Partner ID to be entered on the enrollment packet.Valid Trading Partner IDs will only start with the letters A, B, C, or D; followed by thenumbers “08” and then six additional numbers.Examples of a valid Trading Partner ID format include:B08123456C08123456D08123456Who should I put for the Contact First NameContact Last Name, and Titlefields?This is the person who would be contacted regarding questions related to the enrollmentpacket and would be authorized to receive information sent by the CEDI Enrollmentteam. The person’s title at the company is placed in the title field.What e-mail address should I put in the Email field?e e-mail address entered in this field will be used by CEDI Enrollment to sendcommunication regarding the enrollment packet. Please be sure to use an e-mailaddress that is frequently checked.What is the NPI number?This is the National Provider Identifier.It is a ten-digit number. ��Common Electronic Data Interchange Guided Enrollment Process Last Revision: January 21, 2016 Page of To apply for an NPI, you must contact the National Plan and ProviderEnumeration System (NPPES) at 800--3203 or visit them online athttps:/

4 /nppes.cms.hhs.gov/NPPES/Welcome.do.New
/nppes.cms.hhs.gov/NPPES/Welcome.do.New third party billers(billing services and clearinghouses)who are requesting aTrading Partner ID may enter “0000000000” (ten zeros) if they do not haveestablished clients.What is the PTAN?This is the unique supplier number assigned by the National Supplier Clearinghouse.This is a ten-digit numberThe PTAN can be referred to as the following:Supplier or Provider numberNational Supplier Clearinghouse (NSC) numberDurable medical equipment (DME) numberNew billing services and clearinghouses may enter “0000000000” (ten zeros) ifthey do not have established clieIf you are unsure what this number is or need more information about receiving this number, please contact the NSC at 866--9652 or visit their Web site at http://www.palmettogba.com/nsc. How do I add additional NPIs and PTANs?Once the first NPI and PTAN entered, an additional NPI and PTAN field will bedisplayed. By entering the NPI and PTAN and selecting A, the additional NPI andPTAN combinations will be added to the enrollment packet.Only list NPI and PTAN combinations that use the same Supplier Name listed on theenrollment packet.Up to 25 additional unique NPI and PTAN combinations may be added to the enrollmentpacket.Note: If an NPI and PTAN combination is added and then needs to be removed from theform, select the Remove button.What transaction types are available?Select the type of transactions you are planning to send and/or receive. Verify with yoursoftware provider that you will be able to send the specified file option.e followingtransaction options available to exchange with CEDI.Health Care Claims (837 v5010A1)Health Care Payment/Advice (835 v5010A1)Health Care Claim Status Request & Response (276/277 v5010)NCPDP Claims (version ��Common Electronic Data Interchange Guided Enrollment Process Last Rev

5 ision: January 21, 2016 Page of You ca
ision: January 21, 2016 Page of You can locate approved software vendors for exchanging electronic transactions with CEDI on the CEDI Web site under Approved Entities List. Enrollment Information Which transactions should I select?The transaction options are listed below.Health Care Claim (837)Select this transaction if the Trading Partner will be sending electronic health careclaims on behalf of the supplier to CEDI in the X12 formatHealth Care Claim Status Request & Response (276/277)Select this transaction if the Trading Partner will be exchanging electronic claimstatus inquiry/response transactions on behalf of the supplier.Verify the software product you will be using supports this transaction.Health Care Claim Payment/Advice (8Select this transaction if the Trading Partner will be receiving ElectronicRemittance Advice (ERA) instead of a standard paper remittance advice on behalfof the supplier.NCPDPSelect this transaction if the Trading Partner will be submitting NCPDP formatclaims on behalf of the supplier to CEDI.Only retail pharmacies may submit claims in the NCPDP format; however,retail pharmacies may submit claims in the X12 837 format if they choose.NOTE: This option can only be selected on the form once the GeneralInformation has been completed.Verify with your software vendor what transactions and version types you need to select. Method of Electronic Submission What should I select for “Please select the method you will be using to submityour Electronic Transactions”?Select the method you will be using for sending your claims:Select “Clearinghouse” if you use a Clearinghouse to exchange electronictransactions with CEDI.Select “Billing Service” if you use a Billing Service to exchange electronictransactions with CEDI. ��Common Electronic Data Interchange Guided Enrollment Process

6 Last Revision: January 21, 2016 Page of
Last Revision: January 21, 2016 Page of Select “Direct Biller” if you will be exchanging transactions directly with CEDIthrough the use of a Network Service Vendor. Direct Billers are assigned theirown Trading Partner ID to be used to exchange transactions with CEDI.What clearinghouse/billing service or software vendor will you be usingThis is the name of the clearinghouse/billing service or software vendor you plan to usefor exchanging electronic transactions with CEDI. Contact your software vendor for thisinformation.You can locate approved software vendors for exchanging electronic transactions withCEDI on the CEDI Web site under Approved Entities List-ACE is the HIPAA compliant software available at no cost from CEDI for creating X12claims to be submitted to CEDI. PC-ACE does not create claims in the NCPDP format.Select PC-ACE from the drop down list if you would like to download and use thissoftware to send your Durable Medical Equipment (DME) claims to Medicare. will not be to you. It is available If your software vendor or billing service/clearinghouse is not listed, please verify thatthey are an approved software vendor with CEDI, and then select the “Other” option.You will then be able to enter their contact information.Submitting the Packet Once the General Enrollment Information section is complete andsubmitted, the necessary enrollment forms will be presented. All information previously answered will be auto-populated on each enrollment form. You will need to complete the following on each form to submit the enrollment packet: Verify all fields display the correct information for each form.Complete all remaining required fields (See Additional Information about Forms).Read the Terms and Cditions on each form and check the boxes for each if youagree.Have the authorized person or delegated officia

7 l on file with PECOS enter their namein
l on file with PECOS enter their namein the DME Supplier Name field and their title on the DME Supplier Title field on eachform. The authorized or delegated official’s name entered in the DME Supplier Namefield will be verified against PECOS by CEDI Enrollment.Select the Submit button on each form.The enrollment packet will be faxed to CEDI for processing. Once your packet is submitted, a confirmation message displayed on the screen with the assigned Packet ID (PID) number. This has completed the submission process. You will be given the options to Print This Packet, Finish and Exit, or Start New Packet. Print This Packet This would be for your own reference and the only opportunityto print the packet. The packet is not faxed to CEDI for processing. ��Common Electronic Data Interchange Guided Enrollment Process Last Revision: January 21, 2016 Page of Finish and Exit This will return you to the CEDI Home page.Start New Packet If you wish to submit more than one (1) enrollment packet,this will return you to the beginning of the Guided Enrollment Process to enterinformation for your new packet.The PID for your submitted packet will be e-mailed to your e-mail address submitted on the enrollment packet. Additional Information about Forms CEDI Trading Partner Action Request Form What should be selected for the question “Are you a Clearinghouse or ThirdParty Service?”Check the box if you are a clearinghouse or a billing service who will be exchangingtransactions on behalf of DME suppliers.What should be selected for the question “Are you a Vendor?”Check the box if you are the vendor of the software used to create the transactions tobe exchanged with CEDI.What should I select for the Network Service Vendor drop down boxSelect the Network Service Vendor (NSV) from the drop down list that you will

8 be usingfor connecting to CEDI for sendi
be usingfor connecting to CEDI for sending and receiving files.The list of NSVs approved for connectivity to CEDI is on the CEDI Web site underTelecommunications . CEDI Enrollment Agreement Form What should I put for Trading Partner Name?This is the name the entity that will be exchanging electronic transactions with CEDI.If you send using a clearinghouse or billing service, contact them for thisinformation.If you own the Trading Partner ID, enter your Trading Partner name. CEDI ERA Enrollment Form What information should I use in the Provider Identifiers fields?Providers will enter either the Federal Tax Identification Number (TIN) or the EmployerIdentification Number (EIN) and the National Provider Identifier (NPI).What is the Provider Federal Tax Identification Number (TIN) orEmployer Identification Number (EIN ID)?A Taxpayer Identification Number (TIN) is an identification number used bythe Internal Revenue Service (IRS) in the administration of tax laws. It isissued either by the Social Security Administration (SSA) or by the IRS. ��Common Electronic Data Interchange Guided Enrollment Process Last Revision: January 21, 2016 Page of An Employer Identification Number (EIN) is also known as a federal tax identification number, and is used to identify a business entity. What is the National Provider Identifier (NPI)?The DME billing provider NPI is a unique identification number for coveredhealthcare providers. The NPI is a 10-digit number. CEDI recommends verifying yinked on NationalPlan & Provider Enumeration System (NPPES) crosswalk before on the crosswalktool at the following link: What is Preference for Aggregation of Remittance Data (e.g., Account NumberLinkage to Provider Identifier)?This is the provider preference for grouping (bulking) claim payment remittance advice must match preference for

9 EFT payment. This is intended to collect
EFT payment. This is intended to collect associated numbers(i.e. Tax ID, NPI, TIN, etc.) to enable bundling of ERA receiving entities.Please note the information in this section will not be validated and is the provider’sresponsibility for ensuring the information supplied in this section matches the data theysupply for their EFT notices.Select either Provider TIN or NPI from the drop down list.What is the Provider Federal Tax Identification Number (TIN)?Taxpayer Identification Number (TIN) is an identification number used by theInternal Revenue Service (IRS) in the administration of tax laws. It is issuedeither by the Social Security Administration (SSA) or by the IRS.What is the National Provider Identifier (NPI)? The NPI is a uniqueidentification number for covered healthcare providers.What is the Requested ERA Effective Date?This is the date that the provider will receive only electronic remittance advice. Theprovider will receive both paper and electronic remittances until the selected date.Providers must select a date within 45 days of the date the form submitted.Tracking My Enrollment Packet and Checking Status Once your packet is submitted (See the section on Submitting the Packet), a confirmation message is displayed on the screen with the assigned Packet ID (PID) number. The PID will be sent to the e-mail address provided on the enrollment packet. It will also be listed in the top right corner of the printed pack if you choose to print the packet for your referenceNote: The enrollment packet is NOT faxed to CEDI for processing. PID number can be used to check the status of the packet through the online CEDI Enrollment Status Tool or through the Interactive Voice Response (IVR) system. Both systems allow the status of the enrollment packet to be checked 24 hours a day, 7 days a week. Using the CEDI Enroll

10 ment Status Tool: ��Commo
ment Status Tool: ��Common Electronic Data Interchange Guided Enrollment Process Last Revision: January 21, 2016 Page of The tool will provide an update on the status of your submitted application and is available on the CEDI Web sitewww.ngscedi.com You will need the PID or the NPI, PTAN, and date of the online submission to check the status of the paperwork. More detailed instructions are provided on the CEDI Web site. Using the IVR: To access the IVR, call 866--9184 and select Option 2 from the main menu. The IVR will ask for the Packet ID (RID) or the NPI, PTAN, and date of the online submission for the paperwork. Instructions on how to use the IVR available on the CEDI Web site under CEDI Enrollment. CEDI Gateway Self-Service Password Portal As a CEDI Trading Partner, you will be able to use the CEDI Gateway Self-Service Password Portal located on the CEDI Web site. This provides a simple and secure web-based process for changing/resetting passwords for CEDI Trading Partners and available 24 hours a day, 7 days a week. For your initial setup, access the CEDI Gateway Self-Service Password Portal on our CEDI Web site www.ngscedi.com and enter your security information. This security information is used for changing and resetting your password if it is lost or forgotten. The Password Portal and Instructions are available on the CEDI W site. From the Home page, click on the Gateway Self-Service Password Portal. The next page will take you to the actual portal as well as the instructional guide. If you have any questions, contact the CEDI Help Desk at 866--9184 or via e-mail at ngs.cedihelpdesk@anthem.com. HeW's Trading Partner ID is D08607099 To Receive ERAs To Submit Claims Select Clearinghouse Enter Health-e-Web * Please complete this form. DO NOT complete this form. Please complete this fo