What is an "Approved Vendor"?

There are many software products available on the market through software vendors. The software products available from vendors range from simple claims batching programs to full featured practice management systems that allow medical institutions to input patient data create electronic claim batches, post payment information retrieved from the electronic remittance advice statement, and produce billing statements. Many vendors' products allow the user to bill multiple payers, which is a benefit to some providers.

An "Approved Vendor" is a vendor who has tested their software product with Cahaba to ensure that the file generated by the product can be successfully accepted and satisfactorily pass our front end editing to ensure compliance with HIPAA IG standards. Approved vendors currently have clients using their product to submit claims to us.

Approved Vendors

The Cahaba Approved Vendors list contains the names of vendors, clearinghouses, and billing services that have successfully tested products producing the Health Insurance Portability and Accountability Act (HIPAA) Institutional X 12N 837 Version 4010A1 format. This list is provided for your convenience and should not be construed as a vendor recommendation by Cahaba. Providers must choose and make their own arrangements with vendors. Cahaba is not party to any arrangements between providers and vendors.

When using a Vendor

If a provider contracts with a third party billing agent or clearinghouse/network services vendor, the provider must inform Cahaba who the third party vendor is, and of any changes in vendors. Edits are in place to ensure that electronic transactions submitted or received by a third party have been authorized by the provider. To notify Cahaba, please complete sections I, II and IV of the EDI Services Change Enrollment Application.

If a provider chooses to use a third party to submit or receive electronic transactions on behalf of the provider, the provider is required to have an agreement signed by the third party in which the third party has agreed to meet the same Medicare security and privacy requirements that apply to the provider in regard to viewing or use of Medicare beneficiary data. It is not required to submit such an agreement to Cahaba, but the provider is required to retain the agreement.

Providers are never permitted to share their personal EDI access number and password with any billing agent, clearinghouse/network service vendor, or anyone within their own facility/organization 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,
• To determine the status of a claim.

Third party billers must obtain and use their own unique EDI access number and password from Cahaba EDI Services.

How to become an approved vendor

Billing software vendors, clearinghouses/network services vendors and billing services interested in becoming a Cahaba Part A approved vendor begin by completing the Vendor Testing Form. Vendors are required to have a Cahaba Part A provider client and must meet the same testing criteria that providers must meet. Please see EDI Services Testing Procedures for information regarding requirements and the testing process. After a vendor has successfully completed testing, the vendor will be listed in Cahaba's Part A approved vendor listing.

Page last updated: May 5, 2008

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