Electronic Data Interchange (EDI) Support

Medicare Carriers, Fiscal Intermediaries (FIs), A/B Medicare Administrative Contractors (MACs), and Durable Medical Equipment (DME) MACs as well as the DME MAC Common Electronic Data Interchange (CEDI) contractor furnish first line Electronic Data Interchange (EDI) support to physicians, suppliers and other providers that submit claims and conduct other Health Insurance Portability and Accountability Act (HIPPA) of 1996 named electronic business with the Medicare Part A and Part B program.Providers, billing services, clearinghouses, or other entities that furnish services to providers, shall contact the following:

Carrier or A/B MAC – For professional claims, by geographic area in which the provider operates.
FI or A/B MAC – For institutional claims, by FI that a provider chooses to process their claims. This only applies for Title XVIII FIs, as the A/B MACs will be handling institutional claims by geographic area in which the institution operates.

DME MAC or CEDI – For durable medical equipment, claims are submitted by zip code of a beneficiary that receives services or supplies billed to.

Use of EDI transactions allows a provider to submit transactions faster and be paid for claims faster, and to accomplish this at a lower cost than is generally the case for paper or manual transactions.

Medicare contractors can assist you to begin exchanging EDI transactions by furnishing you with enrollment and connectivity information, system access numbers and passwords, information on those transactions supported by Medicare Part A and Part B, and testing with you to assure correct transmission of the EDI formats. Although these contractors can supply limited EDI training, it is the responsibility of physicians, suppliers and other providers and other entities that will be using EDI to train their staff members on use of the hardware, software, and the security and privacy requirements that apply to HIPAA EDI transactions.

You can use the link(s) below to identify the contractor responsible for your EDI connectivity and for further information on the level of support available by the contractor to entities that exchange Medicare HIPAA EDI transactions.

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