ELECTRONIC DATA INTERCHANGE (EDI) ENROLLMENT AGREEMENTElectronic Data Interchange (Edi) Enrollment Agreement • May 8th, 2006
The undersigned provider agrees to the following provisions for submitting Medicare claims electronically to CMS or to CMS’s contractors.
ELECTRONIC DATA INTERCHANGE (EDI) ENROLLMENT AGREEMENTElectronic Data Interchange (Edi) Enrollment Agreement • August 23rd, 2007
The undersigned provider agrees to the following provisions for submitting Medicare claims electronically to CMS or to CMS’s contractors.
Electronic Data Interchange (EDI) Enrollment FormElectronic Data Interchange (Edi) Enrollment Agreement • August 16th, 2012
This Agreement notifies (fill in contractor name here) of the provider’s consent to participate in Electronic Data Interchange (EDI). EDI may include claims and claims attachments, remittances, eligibility/benefits, claim status, and any other electronic information for Medicare data covered under Health Insurance Portability and Accountability Act (HIPAA) Transactions and Code Sets legislation.
