Not only does EDI stand for Electronic Data Interchange, at Highmark Medicare Services, it also stands for Efficient, Direct, and Intelligent. Electronic Data Interchange is the single most effective way to become more Efficient, Direct, and Intelligent in your daily business routine with Medicare. Click here to learn about the advantages EDI offers to save you time and money. If you already believe in the benefits of EDI and are ready to enroll, please print the appropriate form(s) located in the table below and return the completed, signed form(s) to Highmark Medicare Services.

Important Information About Completing EDI Enrollment Forms 

When enrolling for electronic billing or requesting a change to your current EDI setup, the provider name and address reported on all EDI-related Enrollment Forms must match the provider name and address on file at Highmark Medicare Services. The provider name and address on file at Highmark Medicare Services is the legal business name and address you reported on the CMS-855 form when enrolling to become a Medicare provider. If the provider name and address reported on your EDI-related Enrollment Forms do not match the provider name and address on file at Highmark Medicare Services, the forms will be returned to the provider for correction. To avoid delays in your EDI enrollment, report the correct legal name and address.

To Enroll for EDI:

• If you are currently an electronic biller with Highmark Medicare Services and want to change your EDI enrollment status (e.g., to change software vendors, use a billing service or clearinghouse, to obtain a new Submitter ID, etc.), complete and return the "Electronic Data Interchange (EDI) Setup Requirements Form" (Form 8276). Instructions for completing the EDI Setup Requirements Form are also available in the "Enrolling for Electronic Data Interchange" section in the table below.

NOTE: If you are submitting a CMS-855 form to Highmark Medicare Services and want to be set up for electronic billing, you may mail the required Electronic Data Interchange (EDI) Enrollment forms to Highmark Medicare Services along with the CMS-855 form.  Once Provider Enrollment Services assigns you a Provider Transaction Access Number (PTAN), they will forward the EDI Enrollment forms to Medicare EDI Services for processing.  If you are an existing biller and have a change in your PTAN, you will need to enroll the new PTAN with EDI to have it linked to your Submitter ID.  The CMS-855 form is located on our Web site. 

NOTE: The Amendment to Electronic Data Interchange (EDI) Agreement Form (8259-1) is no longer required (with the new enrollment process) when using a Billing Service or Clearinghouse. The text from this form has been incorporated directly into both the 8275 and 8276 forms.

To Enroll for Electronic Remittance Advice (ERA):

• Complete and return the "Electronic Remittance Advice Enrollment Form."

To Enroll for Electronic Funds Transfer (EFT):
NOTE: This form must be printed as a one-page, double-sided form or it will not be accepted for processing. A cancelled check, voided deposit slip, or bank letter confirming the bank account number and routing number must be attached.

Please return your completed forms to:

Highmark Medicare Services
Attention: Provider Enrollment Services
P.O. Box 890157
Camp Hill, PA 17089-0157

If you need assistance completing these forms, please contact an EDI Analyst at 1-866-488-0546, option 1.

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Enrolling for Electronic Data Interchange (EDI): First Time EDI Customers
DESCRIPTION	FORMAT
Highmark Medicare Services EDI Agreement Form (8275)
Highmark Medicare Services EDI Setup Requirements Form (8276)
Highmark Medicare Services EDI Enrollment Instructions (10202)

Enrolling for Electronic Data Interchange (EDI): Existing EDI Customers
DESCRIPTION	FORMAT
Highmark Medicare Services EDI Setup Requirements Form (8276)
Highmark Medicare Services EDI Enrollment Instructions (10202)

Enrolling for Electronic Remittance Advice (ERA): New and Existing Customers
DESCRIPTION	FORMAT
Highmark Medicare Services ERA Enrollment Form (8262)

 

Enrolling for PC-ACE Pro32 New and Existing Customers
DESCRIPTION	FORMAT
Highmark Medicare Services PC-ACE Pro32 Agreement Form (8287)  **This form is for PC-ACE Pro32 Requests ONLY and must be accompanied by an 8275 and/or 8276 form.

Enrolling for Electronic Funds Transfer (EFT): For EDI and Paper Billers
DESCRIPTION	FORMAT
Authorization Agreement for Electronic Funds Transfer (EFT) (CMS 588) NOTE:A cancelled check, voided deposit slip, or bank letter confirming bank account number and routing number must be attached. Please return your completed EFT form to: Highmark Medicare Services Provider Enrollment Services P.O. Box 890157 Camp Hill, PA  17089-0157

Submitting Medical Documentation for Electronic Claims:
DESCRIPTION	FORMAT
Highmark Medicare Services Cover Sheet for Submitting Medical Documentation for Electronic Claims