J6 NGS: Wisconsin Medicare

National Government Services Inc. (NGS) administers Medicare health insurance for the Centers for Medicare and Medicaid Services (CMS) for Jurisdictions 6. If you are a provider located in Jurisdiction 6 and need to become an electronic submitter for your Medicare A/B Claims, please follow the enrollment instructions below. 

Required Documents for those applying for new Submitter ID's

Part A

The following documents are required enrollment documents that must be completed prior to initiation of electronic claims submission or inquiry. The first 3 forms must be completed in order to transmit claims electronically to NGS. Form #4 can be completed all by itself if all that is needed is access to the FISS/DDE System.

1. EDI Submitter Action Request Form
2. EDI Third-Party Authorization Form (For Billing Services Only)
3. EDI Enrollment Agreement Form
4. Part A Logon Request Form (For access to the FISS/DDE System)

If you have trouble accessing the above links please go here:
http://www.ngsmedicare.com/wps/portal/ngsmedicare/welcome

  • Press Go to NGSMedicare.com
    Select your State and Line of Business and Click "Go to Home Page"
    Click on Enrollment forms and Instructions
    Select Enroll to Submit Claims Electronically

Part B

The following documents are required enrollment documents that must be completed prior to initiation of electronic claims submission or inquiry. 


1. EDI Submitter Action Request Form
2. EDI Third-Party Authorization Form (For Billing Services Only)
3. EDI Enrollment Agreement Form


If you have trouble accessing the above links please go here:
http://www.ngsmedicare.com/wps/portal/ngsmedicare/welcome

  • Press Go to NGSMedicare.com
    Select your State and Line of Business and Click "Go to Home Page"
    Click on Enrollment forms and Instructions
    Select Enroll to Submit Claims Electronically

If you have any questions regarding any of the documents in this package, please call the NGS EDI Technology Support Center at 1-877-273-4334.

 

Submitter Action Request

Section 1

  • Please enter your Business or Provider Name
  • Please complete your demographic and contact information
  • New applicants may enter "None" in the submitter id box
  • Choose your Contractor Code

Section 2

  • Choose "PC-ACE Pro32" or Choose "Other" if you are currently using a different software to generate your EDI 837 files.
  • If you are using SolAce to generate your 837 EDI files, please call our Support Team to get our Vendor information
  • If you are a Billing Service choose "Yes" for 3rd party service, otherwise choose "No"
    • Choose "No" for Vendor
    • Please choose "Claim Shuttle" as your Network Service Vendor
  • Please select "Add New Submitter ID"
  • Enter the PIN/PTAN and NPI numbers that you will be billing for

Section 3

  • Select your Line of Business

Section 4

  • Choose (837) and (835)
  • Enter your name in the Authorizing Signature Name box

EDI Enrollment Agreement Form

  • Enter your name and Demographic Information
  • For Submitter Status choose "New Submitter" and leave the Submitter ID blank
  • Enter your name for the Submitter Name
  • For Submitter Type: choose "Self Biller" or "Billing Service" if you are a billing service
  • Select your Contractor Code
  • Enter your PIN/PTAN and NPI numbers that you will be billing for
  • Check the box to accept the terms and agreement
  • Enter your name in the Authorized Signature Name box

EDI Third-Party Provider Authorization Form (For Billing Services and Providers Using Billing Services)

Note: Billing Services will need to complete this page for each provider they bill for once they receive their Submitter ID from NGS

At the top, please mark off the following transactions you would like to send/receive:

  • 837 Claim
  • 835 Remittance (for electronic EOB's)
  • 276/277 for Claim Status Reports

Submitter/Provider Information

  • Submitter section should be filled in with the Billing Service's information
  • Provider Information should be filled in with the Provider's information that the Billing Service bills for.
    • Signature Name should be the Provider's Name

Part A Logon Request Form (FISS/DDE System)

Section I

  • Please select proper "Action"
    • New applicants should choose "New"

Section II

  • Complete the Requester Section with your information
  • Choose our Contractor Code
  • Choose Claim Shuttle as your Network Service Vendor

Section III

  • Enter the PTAN and NPI numbers that will be used for the FISS access

Section IV

  • Enter the Name, desired 4 digit pin and logon id as well as access level for your user(s)

Section V

  • Enter additional PTANs and NPIs in this section

Section VI

  • Third Party Information should only be filled in if you are using a Billing Service or Clearinghouse

EDI ERA Enrollment Form

http://apps.ngsmedicare.com/applications/edieraenrollmentform.aspx?catid=2

Please fill out this form if you are interested in receiving your remittance advice electronically.

Section 1

  • Please enter your Business or Provider Name
  • Please complete your demographic information

Section 2

  • Select your Jurisdiction/State in the drop down for Contractor Code
  • Enter your TAX ID
  • Enter your NPI
  • If you already have your Trading Partner ID also called a Submitter ID, enter it. If not, leave blank and submit this form with the rest of your enrollment paperwork

Section 3

  • If you are using a billing service to submit your EDI Files enter their information in this section
  • If you are a direct submitter and submit your own claims, enter your information

Section 4

  • Select Direct from Contractor as Method of Retrieval

Section 5

  • Leave Clearinghouse Information section blank

Section 6

  • In the drop down for Vendor Name, please select Claimshuttle

Section 7

  • ​Reason for Submission select "New Enrollment"

Section 8

  • Print your Name & Title
  • You will need to sign this form after you submit the form and print it to be faxed

Section 9

  • Enter the Provider's Name, Title, & Address
  • The Provider must sign this form after it has been submitted and printed to be faxed

 

 

Submitting your Forms

ALL pages of ALL forms must be SIGNED, DATED, and FAXED to 502-889-4701 within 10 business days or the request will be rejected. Please be sure to fax multiple forms for the same request TOGETHER and include a cover letter. Faxes not received within 10 days of submitting the form(s) on line will be rejected and new forms will be required to be submitted.

Waiting for a Response

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 two weeks, contact the Technology Support Center toll-free at 1-877-273-4334.

Testing

Once you have received your Submitter ID and Password from NGS, please call the ClaimShuttle Support Team and set up an appointment for 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.

ClaimShuttle Testimonials

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