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September 16, 2021

Who to Contact Regarding Your EDI Applications!

In recent weeks, the Provider Contact Center has received a high number of inquiries regarding the EDI applications. However, providers and suppliers are contacting our Provider Enrollment Customer Service, instead of EDI.

To ensure providers and suppliers are contacting the correct Customer Service line, please see the chart below for your application questions:

  • Part A – 866.590.6703
  • Part B – 866.276.9558
  • HH&H – 877.299.4500
Electronic Data Interchange (EDI) Applications Provider Enrollment (PE) Applications

Part A, Part B, and HH&H

  • Administrative Simplification Compliance Act (ASCA) Request Form
  • Annual DDE PPTN Recertification Form
  • EDI Enrollment Agreement Form
  • EDI Enrollment Package
  • EDI Network Service Agreement
  • EDI Testing Application
  • J15 DDE PPTN Application/Reactivation
  • Online EDI Application

Select Option 2for an EDI Customer Service Representative.

Part A and HH&H

  • CMS-855A
  • CMS-588
  • Electronic Funds Transfer
  • Exhibit 177 (Part A Only)
  • Authorized and Delegated Officials

Part B

  • CMS-20134
  • CMS 855B
  • CMS-855I
  • CMS-855O
  • CMS-855R
  • CMS 588
  • Electronic Funds Transfer
  • Opt-Out Affidavit Form
  • Participating Providers Agreement CMS-460
  • Authorized and Delegated Officials

Select Option 3 for an PE Customer Service Representative.


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