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Electronic Data Interchange (EDI) is the process of transacting business
electronically. It includes submitting payment requests electronically
(paperless payment request processing) as well as electronic funds transfer
(EFT) and electronic inquiry for payment request status.
The
Section 1011 Final Policy requires all provider types to submit payment
requests electronically. Facilities may submit payment requests via Direct Data
Entry (DDE) or facility charges only through Electronic Media Claims (EMC)
while any physician or ambulance payment requests must be submitted through
DDE.
The Technology Support Center is available to assist with filling out EDI forms,
status of EDI enrollment and EDI technical issues. Please contact the
Technology Support Center at (866) 749-4302.
Completed EDI enrollment forms may be mailed or faxed to the following address:
TrailBlazer Health Enterprises, LLC
EDI Section 1011
P.O. Box 4898
Timonium, MD 21093
FAX (410) 683-2937
All providers, regardless of type, must complete the EDI enrollment forms.
EDI Enrollment Packet
For those providers who choose to connect using AT&T Global Network, the
documentation and Passport for Windows software may be found at the following
link:
http://www.ivans.com/downloads/
Please be sure to download:
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AT&T Global Network Client.
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Passport IP.
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User Guides.
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Hospitals only may submit payment requests via DDE or through EMC (facility
charges only). Below are the additional resources to assist Hospitals in
submitting payment requests:
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Physicians and ambulance providers must submit payment requests via DDE. Please
complete the following documents from the EDI enrollment packet listed above:
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Registration Form.
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Online Services Enrollment.
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IVANS agreement (if applicable).
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Once a PV ID has been issued, a fax will be sent that notes the ID. The PV ID
grants access to the Section 1011 DDE front end and the Undocumented Alien
Reimbursement System. This ID allows payment requests to be entered and DDE
submitters to check the status of payment requests.
Once a new PV ID is issued, the user/owner of the PV ID must log in within the
first 30 days of receipt. After the initial login, the 60-day rule
applies.
You must log in using your PV ID at least every 60 days to keep it
active. Failure to perform a login using the PV ID every 60 days will cause the
ID to expire. Once a PV ID has expired, you will be required to resubmit page 8
of the EDI Enrollment packet for a new PV ID. A new PV ID cannot be issued on
the same day it is requested. Additionally, please log in using your PV ID
at least two weeks prior to the last day that payment requests may be submitted
for any given quarter to ensure the PV ID is active and there are no problems.
A PV ID is required for each user within an organization. (Example: ABC
Hospital has three staff members who will submit Section 1011 payment requests.
Three PV ID's are required. The three staff members may not share one ID.)
The above rules are applied in order to establish security on the data that
each PV ID is able to access. This provides protection for both TrailBlazer and
providers. (For example: Jane Doe leaves ABC Hospital and now works for XYZ
Hospital. ABC Hospital should contact TrailBlazer to have her PV ID
deactivated. Failure to do so will allow Jane Doe to access ABC Hospital's
information while working at XYZ Hospital.)
TrailBlazer has established these rules to ensure that access is kept current.
If a PV ID is not used within 60 days, the ID expires for lack of use.
Again, this is a security feature to ensure only active users have access to
the system.
Please
click here for a review of the GPNet Front End Connectivity Centra
presentation.
Please
click here to review additional information regarding EDI.
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