news article details

Knowing Where to Look for EDI Enrollment Packet Data

Periodically, EDI Enrollment will be publishing articles to help eliminate the number of EDI applications that are denied.

Signature is Incorrect:

All EDI documents require that the person signing the forms must be listed as an Authorized or Delegated Official* (see the instructions below to navigate the CMS-855/PECOS). The signature must be spelled EXACTLY as it was submitted to CMS on the 855 applications. It must include the first and last name of the Authorized or Delegated Official as it was approved including hyphenated names, apostrophes, suffixes, middle names/initials and abbreviations of titles.

To view the approved Medicare Enrollment Record, the provider/facility may access PECOS:

  • Login to PECOS
  • My Associates
  • To the right of the legal name in question (provider/facility) select “View Enrollment”
  • Find the enrollment record for the PTAN in question
    • Select “View Approved Enrollment Record”
  • Go to Section 6: Ownership and/or Managing Control (Individual)
    • Find the AO/DO to verify “How the name is populated”
      • Example:
        • John W Sample Jr
        • Mary Ann Doe
        • Maryanne J Doe

A third party entity may not sign on behalf of the provider. Billing Services, Clearinghouses, or any third party entity associated with the provider are not authorized to sign the EDI documents in place of or for the provider/facility. These types of signatures will not be accepted.

The Provider Name is Invalid:

The provider name listed does not match the Medicare system. The name must be an EXACT match of the Legal Business Name as it was enrolled in the Medicare System, this must include the Business Type (LLC, CORP, Inc., etc.).

The Address is Incorrect:

The address listed for the provider does not match the physical address listed in the Medicare system. The address must be an EXACT match of the physical address on file in the Medicare System. This may include suite/apartment, direction, or street/road designation. This is not an inclusive list. If there has been a change to the location of the provider, it must be submitted and approved on the CMS-855 application prior to submitting it on any EDI Requests.

The provider/facility may review their approved paper 855 application or access PECOS.

Viewing an address in PECOS:

  • Click on my associates
  • Click on View enrollments next to the providers name (group or sole prop)
  • Scroll down to the existing enrollments box
  • Select View approved enrollment record
  • After opening the approved enrollment, the provider will scroll down to the address section of PECOS. click view and view the addresses listed to copy exactly.

Any EDI Documents that are rejected will require a new submission with the correct information.

Posted 12/15/2023