Please follow the Enrollment Instructions below to become an electronic submitter for North Carolina Medicaid.

Required Documents for those applying for new Submitter ID's

The following documents are required enrollment documents that must be completed, signed and returned to the DHHS office prior to initiation of electronic claims submission or inquiry.

1. Trading Partner Agreement

The Trading Partner Agreement will become available once you enroll as a billing agent within Ramp Management. For information on how to obtain an account please call the NCMMIS EDI Help Desk at 1-800-688-6696 or email NCMMIS_EDI_Support@csra.com

We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.

Trading Partner Agreement

• Enter your name as the trading partner and leave the log on id blank

• Enter the Provider Number(s)

• Software Name: Please enter the information for the software or vendor that creates your 837 files you need ClaimShuttle to transfer for you. If you have paid for our billing software please call our support line for our software information.

General
Section I: Please enter today's date
Section IA 1-4: Please enter your facility address and information for the main contact person for your office
Section VIII: Please sign and date both lines

Appendix A: Transaction Sets
Section 1: Please choose the following:

• For UB04 Claims-Institutional Claim: ASC X12N 837 004010X096A1 - Health Care Claim: Institutional

  • In the future this should change from 837 004010X096A1 to 005010X223A1 for 5010 transactions

• For CMS 1500- Professional Claim: ASC X12N 837 004010X098A1 - Health Care Claim: Professional

  • In the future this should change from 837 004010X098A1 to 005010X222A1 for 5010 transactions

• Health Care Payment and Remittance Advice:………(To receive your EOBs electronically)

• Transmission Receipt Verification ASC X12 997 004010

  • In the future this should change from X12 997 to X12 999 for 5010 transactions

Sign and Date both lines and the bottom

Appendix B: EDS Communications and Contact Information
Section 1: Please Choose the following

• Secure FTP Communication

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records

Mail the Trading Partner Packet to:

HP Enterprise Services
2610 Wycliff Road, Suite 401
Raleigh, NC 27607
Attention: ECS Department - TPA

It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two to three weeks from the date of receipt. (Remember that mailing time can take as much as five days.)

After processing, a confirmation will be faxed to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after three weeks, contact the EDI Help Desk NCMMIS EDI Help Desk at 1-800-688-6696 or email NCMMIS_EDI_Support@csra.com

There will be no need to send Test claims. Once you are set up to send claims they will be going straight to production for payment.