The Centers for Medicare & Medicaid Services (CMS) standard Electronic Data Interchange (EDI) enrollment form must be completed prior to submitting Electronic Media Claims (EMCs) or other EDI transactions to Medicare. The agreement must be executed by each provider of health care services, physician, or supplier that intends to submit EMC or use EDI, either directly with Medicare or through a billing service or clearinghouse.
Each new EMC biller must sign the form and submit it to their local Medicare Administrative Contractor (MAC) or Durable Medicare Equipment (DME) MAC.
For more information regarding the CMS Standard EDI Enrollment Form, please contact your local A/B MAC or DME MAC.
An organization comprising of multiple components that have been assigned Medicare provider numbers, supplier numbers, or UPINs may elect to execute a single EDI Enrollment Form on behalf of the organizational components to which these numbers have been assigned. The organization as a whole is held responsible for the performance of its components.
See the Medicare Claims Processing Manual (Pub.100-04), Chapter 24, and Sections 30 – 30.4 for further information.