Please follow the Enrollment Instructions below to become an electronic submitter for Georgia Medicaid

Required Documents for those applying for new Submitter IDs

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

1. Trading Partner Agreement (Provider)
2. SFTP Access Request Form
3. EDI Submitter Update Form

If the links listed above do not work properly, please download these forms from here:

Registration Forms (georgia.gov)

• You will find the forms listed above at the very bottom of the web page under the “Registration Forms” section.

If you have any questions regarding any of the documents in this package, please phone the HP EDI Technology Support Center at 1-877-261-8785.

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 and Enrollment form for Providers

Section 1

• Select Provider

  • Choose Individual or Group

• Please enter your Business, Practice, or Provider name

• Enter your Medicaid Provider number or your Medicaid Group number

• Enter your Tax ID and NPI number

• Enter your demographic information

Section 2

• Enter your contact information

Section 3

• Select “Secure File Transfer Protocol (SFTP)

• Select “No” for the PES software

Section 4

• Select “837P Professional Claims” or “837I Institutional Claims”

Section 5

• Please sign and date the bottom of the page

Secure FTP User Account Request Form

Section A

• Enter your company/organizations name

• Please enter your Provider ID

• Leave EDI Trading Partner ID blank if you are a new applicant

Section B

• Enter the Primary and Secondary contact information for your office

• Check all three boxes at the bottom of the form

HP EDI Submitter Update Form

(this form is to ensure your submitter ID is linked with your electronic remits, please fill this form AFTER you get your HP EDI Trading Partner/Submitter ID)

• Enter your Submitter Identification information in section A

• Skip to section C and check the box “I wish to add the following transaction types…”

• Select the box for 835

• Print your name, sign and Date the application

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records. Fax the enrollment forms reflecting original signatures to:

866-483-1044 attn: EDI Services Unit

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 weeks from the date of receipt. (Remember that mailing time can take as much as five days.)

After processing, a confirmation will be mailed to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the HP EDI Technology Support Center at 1-877-261-8785.

Testing

Once you have received your Submitter ID and Password from EDI Services, please call the ClaimShuttle Support Team and set an appointment for a Mailbox setup and Test Transmission.

Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.