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Electronic Data Interchange

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EDI E-mail Inquiry Form Assistance

*Required Field - An asterisk adjacent to the form field indicates that completion is required.

Line of Business List the line of business for this inquiry or issue. Choose from the drop-down box.
Medicare Contractor Code List the state and contractor number. Choose from the drop-down box.
Provider Transaction Access Number (PTAN) List the PTAN associated with this inquiry.
National Provider Identifier (NPI) List the NPI associated with this inquiry.
Submitter ID List the Sender/Submitter or User ID associated with this inquiry.
Organization Name List your facility or company name.
Contact Name List the name of the contact person submitting the inquiry.
Email Address List the email address of the contact person submitting the inquiry.
Telephone Number List the telephone number of the contact person submitting the inquiry. When necessary, National Government Services will use this telephone number to obtain additional information from the customer.
Fax Number List the fax number of the contact person submitting the inquiry
Reason for Inquiry Select from the drop-down menu provided the issue that best describes this inquiry
Detailed Description of Issue List as much detail as possible about this issue/inquiry. To begin a new line, press the “Enter” key
  • If this inquiry is Fiscal Intermediary Standard System (FISS)/Direct Data Entry (DDE) connectivity related, please list your National Government Services FISS/DDE logon ID in the Submitter ID field.
    • List the authentication number:
      • Employee Identification Number (EIN): A nine digit number, possibly alpha-numeric.
      • Personal Identifier Number (PIN): A four digit number.
  • If your inquiry applies to batch submission errors, list the file name, date of submission, error code(s) and description(s).
  • If your inquiry applies to connectivity issues, list the time of issue, Network Service Vendor, error description (s).
Do not include protected health information (PHI) or personally identifiable information (PII) in the email.
EDI E-mail Inquiry Form Assistance
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