Please follow the Enrollment Instructions below to become an electronic submitter for Western Highland.
Required Documents for those applying for new Submitter IDs
The following documents are required documents that must be completed and returned to the Western Highlands office prior to initiation of electronic claim submission or inquiry.
1. Trading Partner Agreement
2. Care Coordination Information Systems (CCIS) User ID Assignment Request
3. 835 Request or Termination Form (to be completed and sent after receipt of submitter id)
If the above links do not work properly, please download the forms from here:
If you have any questions about the enrollment forms or process, please call the EDI Operations Team at 828-225-2785 ext 2173 and ask for Diane Overman. You can also send an email to firstname.lastname@example.org
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
Please Note: You may fax this form in for expedited processing, however you must ALSO submit two signed copies by mail to Western Highland 356 Biltmore Avenue, Asheville, NC 28801
On Page Four, Select the Following Transactions:
Professional Claim: ASC X12N 837 for Professional Claim Submission
Institutional Claim: ASC X23N 837 for Institutional Claim Submission
Health Care Payment and Remittance Advice: ASC X12N 835 for Electronic EOB’s
Implementation Acknowledgment for Health Care Insurance: ASC X12 999
Health Care Claim Acknowledgment: ASC X12 277CA
On Page Five, Fill out the Signature Section on the Left
CCIS User ID Assignment Request
Complete the applicable sections as follows:
Enter your company Name, Address, Phone and your Provider ID on the left
If you are using a Billing Agency enter their information on the right side
Enter your Name and Contact info as well as your role
On the last section sign and date, and have a supervisor enter their signature and phone number
Part II is for WHIS only
835 Request or Termination Form
(Fill out this form after receipt of your Submitter ID to receive your ERAs electronically)
Check Request 835 Set Up
Check 835 Direct to Provider
If using a billing service enter their information in step 2
Enter the Date, you Submitter ID and your Medicaid Provider number
Enter your Providers name and the Contact name and email for your office
Enter the demographic and contact information and have the provider print their name and sign the application.
Return by fax to Western Highlands Network at 828-258-1225.
Submitting your Forms
It is recommended you keep a copy of all forms for your records. Please fax the enrollment forms to:
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, you will receive a phone call as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the EDI Technology Support Center at 828-225-2785 ext. 2173 and ask for Diane Overman.
Once you have received your Submitter ID and Password from Western Highland, 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