E-mail Page
Print- Home
- Part A
Medicare Part A Links
- Claims Processing Issues
- Rates and Fee Schedules
- Deductibles and Coinsurance
- Taxonomy Codes
- Medicare Secondary Payer
- About Provider Enrollment
- Check Status of Current Application
- CMS-855A Packet
- Enrollment Forms
- Electronic Funds Transfer
- Provider-Based Status Determinations
- LCDs and Articles
- LCD Comment and Reconsideration Process
- National Coverage Determinations
- Investigational Devices
- Medical Review
- Signature Guidelines
- Part B
Medicare B Links
- HH + H
Home Health + Hospice Links
- Redetermination
- Reconsideration
- Administrative Law Judge Hearing
- Appeals Council Review
- Final Judicial Review
- Forms
- Active LCDs
- Draft LCDs
- Retired LCDs
- Reconsideration Process
- Home Health Coverage Guidelines
- Hospice Coverage Guidelines
- National Coverage Determinations
- Progressive Corrective Action
- PrePayment Review
- Postpaymet Review
- Additional Development Request
- Comparative Billing Reports
- Denial Reason Codes
- Forms
- FAQ
- Contact Us
EDI Forms
Instructions for Completing EDI Applications
Please read and follow instructions carefully. Applications that do not comply with these guidelines will be rejected and returned.
- Access the application by clicking on the appropriate link below. You must have Adobe 8 or later installed on your system to complete these applications.
- Complete the application by typing your information online, directly into the application.
- Once completed, print the application, obtain an authorized signature, and fax it to Cahaba EDI Services. Applications must be faxed to the number provided in the top right corner of the first page of the application.
- Pages must be faxed in the order printed. Use only the cover page provided with the application and make sure it is the first page faxed.
- Send only one application per fax.
- If an e-mail address is provided on the application, it will be used to send notifications when the application status changes.
- If you are resubmitting an application that has been returned, you must complete and fax a new application.
- Billing services and clearing houses must complete the “EDI Services Part B Billing Service Application.” If using in-house software that requires testing, a provider's “EDI Services Part B Application” is also required. The provider's application must be in front of the billing service application and sent in the same fax.
- Vendors must complete the EDI Services Part B Vendor Application.
- New vendors will need to fax at least one provider's EDI application along with the “EDI Services Part B Vendor Application.” The provider's application must be in front of the vendor application and sent in the same fax.
- For new connectivity vendors the Network Services Agreement with an authorized signature must also be submitted.
- The name, address, and tax ID provided must match the address and tax ID we have associated with the PTAN and NPI in our system.
- If you have any questions contact EDI Services at (866) 582-3253, or via e-mail at PartBEDIServices@cahabagba.com
Click the link to the appropriate application below to begin entering the data. Adobe Acrobat Reader version 8 or later must be installed on the submitter's system to complete the applications.
- Part B EDI Application
- Part B Billing Service Application
- Part B Vendor Application
- Part B Network Service Vendor
Page last updated: February 19, 2010
