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EDI Forms

New Instructions for Completing EDI Forms and Applications

Applications are processed within seven (7) days of the date we receive them. Please allow two (2) business days after the date of your approval letter before you begin submitting your claims electronically.  This will allow for our internal processes to complete.

Supporting CMS Directive Effective April 1, 2012.

Please read and follow instructions carefully. Applications that do not comply with these guidelines will be rejected and returned.


  1. Complete the Application
    • 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 online, directly into the application. Cahaba GBA cannot accept handwritten information on an application. If you are resubmitting an application that has been returned, you must complete and fax a new application. Cahaba GBA cannot process manual corrections to returned applications. All fields outlined in red are required and must be completed before you will be able to print the application.
    • Provider Contact Name, email address, and phone number must be a contact person who works for the provider and not a billing service, clearing house, or software vendor.
    • The name, address, PTAN, NPI, and tax ID number provided must match the name, street address and tax ID we have associated with the PTAN and NPI in our system for the practice. 
    • Verify your ERA selection – When completing the EDI Part B Application, if you select ERA on the application this will change the submitter ID for ALL ERA’s. If you DO NOT select ERA for the submitter ID listed on the application, your ERA’s will continue to be returned to the submitter ID on the provider file that was previously set-up to receive the ERA’s, regardless of when this set-up occurred.
    • Be sure to include your billing service or clearing house information if applicable. For best results fax your application directly to Cahaba GBA. Many clearing houses may offer to forward your faxed application to Cahaba GBA. This can cause the bar code on the first page to become distorted and could result in a delay in the processing of your application.
    • Print the application – If a required field (outlined in red) is not complete, you will get an error message.  You will need to fill in the missing information before you will be able to print the application.
    • Providers completing the “Part B EDI Application” must enter the street address we have on file for the PTAN used on the application. A Post Office (P. O.) Box is not acceptable and will cause the application to be returned to you. If you have a question about your street address please contact Provider Enrollment at (877) 567-7271.
  2. Obtain Authorized Signatures
    1. Applications must be signed by an authorized representative of the practice; software vendors, billing services, and/or clearing houses are not permitted to sign on behalf of the provider.
    2. An authorized signature must appear in the signature section on page 5.
  3. Fax Application to Cahaba GBA EDI Help Desk  
    1. Fax Application to Cahaba GBA EDI Help Desk within 90 days of the date of the signature.
    2. Verify that the “Bar Code” is present on the fax cover sheet
    3. Use only the cover page provided with the application and make sure it is the first page faxed.
    4. Make sure pages are faxed in the order printed
    5. Send only one application per fax.
    6. Fax Application to Cahaba EDI Services within 90 days of the date of the signature.


  1. New billing services and clearing houses must complete EDI’s “Part B Billing Service Application”. A provider’s “Part B EDI Application” is also required. The provider’s application must be in front of the billing service application and sent in the same fax. Billing services and clearing houses must complete the “Part B Vendor Application” if updating company information.
  2. New Software Vendors will need to fax at least one provider’s “Part B EDI Application” along with EDI’s “Part B Vendor Application”. The provider’s application must be in front of the vendor application and sent in the same fax. Software Vendor’s must complete EDI’s “Part B Vendor Application” if updating company information.
  3. New Network Service Vendors need to complete the “Part B Network Service Vendor” application to include an authorized signature.
  4. Be sure the name, address and tax ID provided matches the address and tax ID we have associated with the PTAN and NPI in our system.

If you have any questions contact the EDI Help Desk at (866) 582-3253, or via e-mail at


For some Mac computers the bar code on the first page of the Part B EDI Application, Part B Billing Service Application, the Part B Network Service Vendor Applications, and the Part B Vendor Application may not appear. If this is the case you will need to access the forms and complete them on another, Windows-based computer where the bar code will appear.


If you are using the Google Chrome Internet Browser the bar code on the first page may not appear. In this case you would need to complete the application using Internet Explorer. 

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.

Page last updated: May 29, 2014

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