Please follow the Enrollment Instructions below to become an electronic submiter for Vermont 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 VT Medicaid office prior to initiation of electronic claims submission or inquiry.
1. EDI Registration Form
2. Trading Partner Agreement
3. 835 ERA Enrollment Form
If the links listed above do not work properly, please download them from:
If you have any questions regarding any of the documents in this package, please call the VT Medicaid EDI Technology Support Center at 1-802-859-4450, Option 3.
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
In the first paragraph, enter your business name on the blank line provided
On section 2.3 for the Trading Partner section, enter your business information
On section 6.2 for “Mode of Claim Submission” select “Data Transmission via Vermont Medicaid Portal”
Enter the numbers of providers that you will bill for and your estimated claim volume per month and how many times you think you will bill per week (for example enter “ 10x/wk”)
On Article VIL, provide the contact information of the main contact person for your office
Sign the Trading Partner section under the Agreement Execution section
Enter your Business or Provider name, demographic information, and contact information
Please verify with your software vendor that they are a Certified Vendor. If you have purchased our software please call us for that information
Select 837 Professional or 837 Institutional, 835 Remittance, 999 Functional Acknowledgment, Claim Accept/Reject Report, and 276/277 Claim Status Inquirer/Response
New applicants may leave the Trading Partner ID box blank
Enter the information requested on the table for the providers that you will be billing for
Select either 837P or 837I, 997, Claim Accept/Reject Report, and 835 (for electronic EOBs)
Submitting your Forms
It is recommended that you keep a copy of all the forms you will be submitting for your records. Mail the enrollment forms reflecting original signatures to:
Attn: EDI Coordinator
PO Box 888
Williston, VT 05495-0888
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 Technology Support Center at 1-802-857-2936.
Once you have received your Submitter ID, Trading Partner ID and Password from VT Medicaid, 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.