EDI Enrollment and Registration (AKA Trading Partner

30 - EDI Enrollment and Registration (AKA Trading Partner Agreements) (Rev. 13105; Issued- 04-10-25; Effective: 05-12-25; Implementation: 05-12-25) Medicare FFS’ Trading Partner Agreement is comprised of two forms: 1) EDI Registration and 2) EDI Enrollment. The forms are identified under CMS form 10164 and can be accessed at: EDI Registration - https://www.cms.gov/files/document/cms-10164a.pdf and EDI Enrollment - https://www.cms.gov/files/document/cms-10164b.pdf CMS 10164A EDI Registration and 10164B EDI Enrollment forms have been watermarked as ‘SAMPLE’ forms with the Office of Management & Budget (OMB) approval of the 2024 EDI Paperwork Reduction Act (PRA) Package. The A/B MACs and CEDI are currently using their own organization specific forms that are comparable in terms of content to the CMS Sample forms 10164A and 10164B, to transmit data files electronically between themselves and their trading partners. The A/B MACs and CEDI Organization specific EDI Registration and EDI Enrollment forms must include the OMB number at the bottom of the forms: OMB No. 0938-0983 approved by CMS. The A/B MACs and CEDI Organization specific EDI Enrollment form must include the following notice: NOTICE: Federal law and applicable regulation and guidance, including IOM Pub. 100- 04, Chapter 24, Section 30.2, shall govern both the interpretation of this document and the appropriate jurisdiction and venue for appealing any final decision made by CMS under this document. This document shall become effective when signed by the provider. The responsibilities and obligations contained in this document will remain in effect as long as Medicare/Section 1011 claims or any other EDI transactions are submitted to CMS or the CMS contractor. Either party may terminate this arrangement by giving the other party thirty (30) days written notice of its intent to terminate, except as noted in applicable regulation and guidance, including IOM Pub. 100-04, Chapter 24 , Section 30.2. In the event that the notice is mailed, the written notice of termination shall be deemed to have been given upon the date of mailing, as established by the postmark or other appropriate evidence of transmittal. EDI registration and enrollment shall be instituted by the A/B MACs and CEDI and shall accomplish the following: 1. Document the specific type of transactions and transmission methods to be utilized and secure authorizations from the provider or other trading partner requesting to exchange electronic administrative transactions, and 2. Designate the A/B MACs and CEDI with whom the provider or other trading partner agrees to engage in EDI and implements standard policies and practices to ensure the security and integrity of the information to be exchanged. Under HIPAA, EDI applies to all covered entities transmitting the following administrative transactions: ASC X12 837 institutional claim and ASC X12 837 professional claim, ASC X12 837 dental claim, ASC X12 835 remittance advice, ASC X12 270/271 eligibility, ASC X12 276/277 claim status and NCPDP claim (and others that are not used by Medicare at this time). Beginning on January 1, 2012, A/B MACs and CEDI will also use the ASC X12 TA1 interchange acknowledgment, ASC X12 999 implementation acknowledgment and ASC X12 277CA claim acknowledgment error handling transactions. In addition, CEDI and DME MACs will also use the NCPDP standard transmission response transaction. Entities who prepare and submit the CMS 1500, CMS 1450 or CMS 10883 ADA Dental paper claim forms do not need to complete an EDI registration.