NGS Illinios Part A Workload (00131) EDC Migration

With the transition to the Enterprise Data Center, NGS is required to replace your current FISS/DDE User Ids with new IDs. To facilitate this task we are requiring that Patient Account Managers complete and submit the information contained in the online form below. Once the new User IDs are created, the NGS EDI Department will communicate these to you based on the Preferred Contact Method indicated in the form. Please note that all the information on the form is required. If you have any questions about the transition, please email us at NGS_EDI_PARTA@WELLPOINT.COM

This notification is to advise all National Government Services, Inc. providers of our upcoming transition from the NGS Data Center to the EDS Data Center for our Part A Illinois workload only.

We ask that you complete and submit this online form no later than July 30, 2008. Failure to receive this information by this date will jeopardize your facility's ability to access the FISS/DDE system when the transition is implemented on August 26, 2008.

Provider/Facility Name (required):

FISS User ID Contact Name (required):

Title (required):

Phone (required):

City (required):

State (required):

Fax:

Email (required):

Preferred Contact Method:

Medicare Legacy Provider Numbers:

1.	2.
3.	4.
5.	6.

To submit additional provider numbers check here

Please list all of your facility's current FISS IDs if you need to enter more then 20 FISS IDs an additional form will need to be completed.

* If you do not check the "Update Capability" box, your new ID will automatically be given INQUIRY ONLY access and you will not be allowed to make any changes within the FISS/DDE System.

ID	First Name:	Last Name:	Update Capability *
1.	First Name	Last Name	Update
2.	First Name	Last Name	Update
3.	First Name	Last Name	Update
4.	First Name	Last Name	Update
5.	First Name	Last Name	Update
6.	First Name	Last Name	Update
7.	First Name	Last Name	Update
8.	First Name	Last Name	Update
9.	First Name	Last Name	Update
10.	First Name	Last Name	Update
11.	First Name	Last Name	Update
12.	First Name	Last Name	Update
13.	First Name	Last Name	Update
14.	First Name	Last Name	Update
15.	First Name	Last Name	Update
16.	First Name	Last Name	Update
17.	First Name	Last Name	Update
18.	First Name	Last Name	Update
19.	First Name	Last Name	Update
20.	First Name	Last Name	Update

SYSTEM AVAILABILITY (Including IVR):
6:00 a.m. - 7:00 p.m. Central Standard Time (CST) - Monday-Friday
6:00 a.m. - 12:00 p.m. Central Standard Time (CST) - Saturday

Page Last Modified: 06/26/2008