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EDI Enrollment Request 837 and 27x Transaction An Independent Licensee of the Blue Cross and Blue Shield Association SECTION I Vendor×Clearinghouse Name Phone Ext Contact Name Blue Cross Vendor ID

How to fill out edi enrollment request 837

How to fill out an EDI enrollment request 837:

Gather necessary information:

1. Identify the healthcare provider or organization submitting the request.
2. Collect the provider's contact information, such as name, address, and phone number.
3. Have the provider's National Provider Identifier (NPI) handy.
4. Obtain the provider's Tax Identification Number (TIN).

Obtain the required forms:

1. Go to the relevant healthcare payer's website or contact their customer service.
2. Request the EDI enrollment form specifically for the 837 transaction.
3. Ensure you have the most up-to-date version of the form.

Fill out the form accurately:

1. Provide the provider's details in the designated fields, including name, address, and contact information.
2. Enter the provider's NPI and TIN correctly.
3. Complete any other sections that are required on the form, such as the provider's specialty or practice type.

Include supporting documents, if needed:

1. Some payers may require additional documentation along with the enrollment form.
2. Examples of supporting documents may include a copy of the provider's professional license or proof of accreditation.

Review the completed form:

1. Double-check all the provided information for accuracy.
2. Ensure that all required fields are completed.
3. Review the form for any spelling or typographical errors.

Submit the enrollment request:

1. Follow the instructions on the form or provided by the payer to submit the EDI enrollment request.
2. Determine whether the payer accepts electronic submission, fax, or mail.
3. Send the completed form and any supporting documents if necessary.

Who needs an EDI enrollment request 837?

1. Healthcare providers: Any healthcare provider, including hospitals, clinics, physicians, dentists, and other professionals, who wish to electronically submit medical claims and related information to health insurance payers may need to complete an EDI enrollment request 837.
2. Healthcare organizations: Larger healthcare organizations, such as hospital systems or medical billing companies, may also need to submit an EDI enrollment request 837 on behalf of their affiliated providers.
3. Health insurance payers: Payers, such as insurance companies or government programs (e.g., Medicare or Medicaid), require healthcare providers to submit claims electronically through the EDI process. Therefore, they may require providers to complete the EDI enrollment request 837 to ensure accurate and efficient claims processing.

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