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Enrolling with CEDI is easy!
CEDI enrollment documents are completed and submitted on-line.
After completing any of the on-line forms below, you must
click on the “Submit” button, print, sign and fax the
form to the number located on the printed form. Do not print
the screen before you click on “Submit”.
IMPORTANT: Forms that are not printed after clicking on “Submit”
and/or are not signed and faxed to CEDI will not be processed.
Form |
Complete for: |
| CMS
EDI Enrollment Form |
Every New DME MAC Electronic Trading Partner (If you do not already have an existing Sender or Submitter ID, please
complete the Submitter Action Request Form along with the EDI Enrollment form.) |
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Trading Partners to add a new PTAN/NSC or NPI number to an
existing Submitter ID |
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| Supplier
Submitter Action Request Form |
Every new DME MAC Electronic Trading Partner (Must also complete
the CMS EDI Enrollment Form) |
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Ordering the Express Plus Software Program (Check box included
on the form, under Section II - SOFTWARE VENDOR) |
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Existing Trading Partners to: |
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• Request the addition of a new transaction |
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• Changing a file transfer option |
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• Changing software vendors |
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• Update contact information |
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| Supplier
Authorization Form |
Suppliers using a Clearinghouse, Billing Service or other
Third Party to exchange any transactions with CEDI (This includes
claims, ERAs and 276/277 transactions.) |
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Existing Trading Partners changing to a Clearinghouse, Billing
Service or Third Party Biller |
When CEDI forms are submitted, an acknowledgment email will be
generated and sent back to the email address entered on the form.
Once the request has been approved and processed, a setup confirmation
will be sent via email. For security purposes, confirmation of enrollment
requests for a new Trading Partner (Submitter) ID requiring a password
will be sent in two emails. The Trading Partner (Submitter) ID and
connectivity information will be included in the first email and
the password will be sent in the second email. If an email address
is not provided on the forms or if the email is returned as undeliverable,
CEDI will respond with the setup confirmation via fax or mail.
The initial password is a default password which will expire
immediately and requires the user to establish a confidential, unique
password. Passwords will expire every 90 days.
Password configuration requirements are as follows:
- Passwords must be eight (8) characters in length. No more and
no less.
- Passwords must contain a combination of number and alpha characters.
- Passwords must contain a special character, for example (@,
#, $).
- Passwords are only good for 90 days, at which time the user
must reset it.
- Passwords cannot be changed by the user more than once per
day.
- After three incorrect login attempts, the ID will be revoked.
Please disconnect and re-try prior to the third attempt.
- The ID history retains the last 12 passwords the user has used.
These cannot be reused.
- Must not be stored in scripts, files, or applications unless
compensating controls are in place
Note: Trading Partner IDs will automatically
suspend after 365 days of inactivity
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