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I Am Not Yet Enrolled in Medicare

Last Modified: 2/1/17
EDI Email Inquiry Form EDI Help Desk Post Call Survey Link

Contact the EDI Help Desk:

Jurisdiction 6: 877-273-4334

Jurisdiction K: 888-379-9132

Available by phone or email Monday–Friday*
8:00 a.m.–5:00 p.m. ET
7:00 a.m.–4:00 p.m. CT

* Closed for training on the 2nd and 4th Friday of the month.
12:00 p.m.–4:00 p.m. ET
11:00 a.m.–3:00 p.m. CT

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Benefits of using EDI Transactions

There are a number of advantages to enrolling and submitting claims online. Claims and other transactions submitted electronically process considerably faster than paper submission. For example, HIPAA-compliant electronic claims are held in the payment floor for 14 days whereas paper claims are held in the payment floor for 29 days.

Some of the other advantages of electronic submission include:

  • Increased cash flow and lower administrative costs
  • Ease of billing
  • Added efficiency and accurate claims filing

Receive the Electronic Remittance Advice

ERA is an EDI transaction that allows you to receive payment information via e-mail or another electronic format. If you have the software, an ERA file created by Medicare can be automatically posted to your accounts receivable system. Once the ERA is in place, the payment posting process is more efficient and accurate. Other ERA benefits include:

  • Faster communication and payment
  • Faster account reconciliation
  • Improves office productivity
  • Automation of follow-up action
  • Paperwork reduction
  • Detailed information

Note: The SPR will be mailed for a minimum of 31 days after the provider number has been setup for ERA. If you submit through a billing service, clearinghouse, or a submitter/sender ID that is currently receiving ERAs, you will no longer receive the SPR effective with the completion of the ERA setup date.

Help Interpreting the ERA is Available 

If you have any questions about or need help understanding the ERA, please contact the EDI Help Desk by phone or email. If you have questions in regards to claim payment information in the ERA, please contact the Provider Contact Center.

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What is EDI?

EDI, or electronic data interchange, is how computer systems may be used to send and receive Medicare claim information to and from National Government Services. All claim data passes through our “gateway” - think of this as the mainframe where all claim activity happens (claims are received, processed, and either approved or returned). To access the gateway, and get information into and out of the gateway, a standard system of communication is needed, to keep the information secure and as error free as possible.

What is EDI? 

EDI, or electronic data interchange, is how computer systems may be used to send and receive medicare claim information to and from National Government Services. All claim data passes through our “gateway” - think of this as the mainframe where all claim activity happens (claims are received, processed, and either approved or returned). To access the gateway, and get information into and out of the gateway, a standard system of communication is needed, to keep the information secure and as error free as possible.

How Does It Work?

EDI relies on a set of systems that know how to communicate with each other. Some systems securely access the National Government Services data while other systems let you do your work, on your computer, in your office. To connect these systems, there is a “gateway” that can be accessed by a set of approved network service vendors.

How Does It Work?

EDI relies on a set of systems that know how to communicate with each other. Some systems securely access the National Government Services data while other systems let you do your work, on your computer, in your office. To connect these systems, there is a “gateway” that can be accessed by a set of approved network service vendors.

What Can I Do With EDI?

With an EDI implementation, you can prepare and submit claims in the proper format, view data directly from National Government Services’ gateway and receive notices when claims are paid (or returned). Each of these functions requires the correct software. Providers can find a list of National Government Services approved software vendors and clearinghouses on the National Government Services web site to support all functions.  Providers who submit small claim volumes or submit infrequently to Medicare can use the Medicare free software for each function.

Why Is it Required?

ASCA requires all Medicare claims be submitted electronically, with limited exceptions. Submitting electronic claims helps lower administrative costs for the Medicare program and your practice—and, you'll get paid faster too! With that in mind, we realize that sometimes the best solution may be to submit paper claims temporarily. For more information on ASCA, please visit the “ASCA Requirements for Paper Claim Submissions” from the left hand task menu.

What Can I Do With EDI?

With an EDI implementation, you can prepare and submit claims in the proper format, view data directly from National Government Services’ gateway and receive notices when claims are paid (or returned). Each of these functions requires the correct software. Providers can find a list of National Government Services approved software vendors and clearinghouses on the National Government Services web site to support all functions.  Providers who submit small claim volumes or submit infrequently to Medicare can use the Medicare free software for each function.

Why Is it Required?

ASCA requires all Medicare claims be submitted electronically, with limited exceptions. Submitting electronic claims helps lower administrative costs for the Medicare program and your practice—and, you'll get paid faster too! With that in mind, we realize that sometimes the best solution may be to submit paper claims temporarily. For more information on ASCA, please visit the “ASCA Requirements for Paper Claim Submissions” from the left hand task menu.

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