- Entry Process Questions
- General Information
- Choose Transaction Status
- Submitting the Packet
- EDI Enrollment Agreement Form
- EDI ERA Enrollment Form
- EDI Registration Form
- Part A Logon Request Form: Provider/Facility Requesting Access
- Provider Letter of Authorization
- Part A Logon Request Form: Billing Service Using a Letter of Authorization PIN
- Tracking my Enrollment Packet and Checking Status
- EDI Gateway Self-Service Password Portal
EDI Enrollment Agreement Form
This form is a required document by CMS allowing a provider to exchange electronic transactions with the MAC. This form is effective as long as the provider is exchanging Medicare claims with the MAC, carrier, or fiscal intermediary.
Note: If the PTAN/NPI currently has an EDI Enrollment Agreement on file, you are not required to complete an additional agreement. The option is available to proceed in completing an additional agreement.