| EDISS New Submitter Non-Vendor |
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For assistance with these forms send
an e-mail to support@edissweb.com |
NMIC |
MCD IA |
MED A |
MED B |
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1.For which Line(s) of Business will you be sending transactions? |
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| 2. Which transactions would you like to use? |
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| 837I - |
Institutional Electronic Claim Submission | |
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PC-ACE |
| 837P - |
Professional Electronic Claim Submission | |
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PC-ACE |
| 837D - |
Dental Electronic Claim Submission | |
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PC-ACE |
| 835 - |
Electronic Remittance Advice | |
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PC-ACE |
| 270 - |
Health Care Eligibility Benefits Inquiry |
| 271 - |
Health Care Eligibility Benefits Response | |
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| 276 - |
Health Care Claim Status Request |
| 277 - |
Health Care Claim Status Response | |
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PC-ACE |
| 278 - |
Health Care Services Review | |
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| 820 - |
Payroll Deducted and Other Group Premium
Payment for Insurance Products | |
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| 834 - |
Benefit Enrollment and Maintenance | |
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PC-ACE - Transactions supported by PC-ACE software.
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3. What Vendor will you be using to send transactions? |
| 3a. For transactions supported by PC-ACE, what method
of submission will you be using? |
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| 3b. For transactions NOT supported by PC-ACE, what method of submission will you be using? |
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| 4. What method of connectivity will you be using? |
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Press the "Submit" button to determine
which registration forms are needed. |
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