- General Information
- Submitter Type - Provider
- Submitter Type - Provider
- I Am a Provider and “I Want to Connect Directly to the Part A FISS/DDE System”
- I Am a Provider and “I Want to Allow a 3rd Party Billing Service to Bill for Me Using the Part A FISS DDE System”
- I Am a Provider and “I Want to Complete an EDI Registration Form”
- I Am a Provider and “I Want to Complete a Connex Registration Form”
- Submitter Type - Billing Service
- Submitter Type - Clearinghouse
Submitting the Packet
After the enrollment packet is submitted, a confirmation message is displayed on the screen with the assigned Packet ID (PID) number. This has completed the submission process.
You will be given the options to Print this Packet, Finish and Exit, or Start New Packet.
- Print this Packet - This would be for your own reference and the only opportunity to print the packet. The packet is not faxed to EDI for processing.
- Finish and Exit - This will return you to the EDI home page
- Start New Packet - If you wish to submit more than one enrollment packet, this will return you to the beginning of the Guided Enrollment process to enter information for your new packet.
The PID for your submitted packet will be emailed to the email address entered on the enrollment packet.