EDI Services

The Electronic Data Interchange (EDI) Services department provides support for Medicare providers submitting claims electronically for processing by Cahaba.  EDI transactions include health care claims, eligibility and claim status inquiries, remittance advice statements and reports associated with the transmission of electronic files. EDI transactions can be exchanged via a software program that batches the transaction into an electronic file, or by real-time through a computer-to-computer connection to the payer.

Providers may enroll with the EDI Services department to obtain direct electronic access to the Fiscal Intermediary Standard System (FISS).  This allows you to correct claims in the Return to Provider (RTP) file, check the status of claims, review additional development requests (ADRs), and to check beneficiary eligibility via ELGA or ELGH.  In addition, you must contract with a connectivity vendor to establish direct connection to the Enterprise Data Center (EDC) for FISS access through a connectivity product.  Refer to the Approved Vendor, Web page to learn more about vendors and to review the Approved Vendor list.  The Electronic Billing with Cahaba booklet also guides you through the options for connectivity, transmission and the EDI enrollment process that establishes the security needed for connectivity.

The EDI Web pages offer the following resources:

• Electronic Data Interchange Enrollment — Learn about the enrollment process and take the steps necessary to conduct business with Medicare electronically. 
• EDI Forms — Refer to this Web page for the necessary application forms to become an electronic biller, or an approved billing service, vendor, or clearing house with Cahaba.
• EDI Connectivity Options — Refer to this Web page for information about the various connectivity options currently available.  There are several ways to establish the connection necessary and the choice that is best for you will depend on the needs of your company.
• EDI Services Testing Procedures —This Web page provides information you need to know to submit a claim test file, receive your results, and prepare for submitting claim files in production.
• Approved Vendors —This resource provides a list of vendors, clearinghouses and billing services that have successfully tested their products with Cahaba. 
• Transaction Formats —Information on this Web page ensures that only the required formats are used to submit electronic transactions.  
• EDI Software Downloads / Instructions—This Web page provides EDI freeware and scripts, documentation for installation instructions, user manuals, and logon instructions to access the Fiscal Intermediary Standard System (FISS).

Effective October 16, 2003, providers are required by law to submit their claims electronically to Medicare, with minimal exceptions. However, all providers, with small or large claims volumes, can successfully submit claims electronically. Additional information regarding this requirement can be found on the CMS Web site.

Page last updated: February 23, 2010

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