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CGS Administrators, LLC

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Electronic Data Interchange (EDI)

The submission of claims in an electronic format is a requirement for the vast majority of DME suppliers. Enrolling in the EDI (Electronic Data Interchange) program should be a first step for most DME suppliers. Enrollment into EDI for DME suppliers is handled by the CEDI (Common Electronic Data Interchange) Contractor.

Submitting claims electronically provides several benefits:

  1. Faster payment. Electronic claims are paid earlier than paper claims.
  2. Earlier detection of claim errors. Claims submitted electronically immediately go through a series of editing, reducing the likelihood of claims being denied for payment.
  3. Availability of free software. A free billing software has been developed based on the requirements of the HIPAA-standard format. This software offers valuable features to assist with electronic claim submission, archiving and reporting.
  4. Lower administrative costs. Claims submitted electronically reduce postage and other paper-related expenses while increasing efficiency.
  5. Access to other transactions. In addition to billing claims electronically, suppliers are also able to take advantage of other electronic transactions such as the 835 - Electronic Remittance Advice (ERA)

Contact the CEDI Contractor at NGS CEDExternal Website to enroll in electronic claims processing and find information about other electronic transactions that are available to you.

If you are interested in checking Claim Status or Beneficiary Eligibility online, use our free myCGS online portal. Registration information, user manuals and education are available under the myCGS section of our website. You may also check claim status using a network service provider. Additional information on this process is available under the Online Claim Status Inquiry section of our website.

If you would like to start receiving electronic remittance advice (ERA) instead of receiving the paper explanation of benefits, follow the below steps:

  1. Verify you are capable of receiving the 835 transaction file. If you are a self-biller, verify this information with your software vendor. If you are using a 3rd party biller, verify the information with your billing service/ clearinghouse.
  2. Once the capability is confirmed, you will need to complete the required enrollment form to request the transaction. Under Transaction Options on the form, mark the 835 transaction. If you are a self-biller, complete the Supplier Submitter Action Request Form located on the CEDI website under EDI Enrollment. If you are using a 3rd party biller, complete the Supplier Authorization Form located on the CEDI website under EDI Enrollment.
  3. Print, sign, date, and fax the form to the CEDI Enrollment Department for processing. The fax number is 315-442-4299.
  4. You will receive an e-mail confirmation once request has been completed. You will begin to see the electronic remit files immediately. If your software vendor, billing service, or clearinghouse is able to receive the electronic remittance advise 835 file but does not have a program to translate it into a readable format, the Centers for Medicare & Medicaid Services does offer a free software called Medicare Remit Easy Print.

The program is available to download from the CEDI website www.ngscedi.comExternal Website under Software Downloads and Documentation as well as from the CMS website directly.

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