Enrollment

If you will be submitting electronic claims directly to ACS EDI Gateway, please complete the  ACS EDI Gateway enrollment form.  If you are using a third party vendor to submit electronic claims on your behalf, please contact them and have them complete the enrollment form.  Fax or mail your completed enrollment form to:

Please mail or fax forms to:
EDI Enrollment Unit
ACS EDI Gateway, Inc.
2324 Killearn Center Blvd.
Tallahassee, FL  32309
Fax:  (850) 385-1705

EDI Submitter Enrollment Packet: The enrollment packet consists of the following documents. To download these forms, please click on the document link below.

• ACS EDI Gateway enrollment form

If you are enrolling to submit electronic medical bills for Allstate Insurance company, Deerbrook Insurance Company, and/or Encompass Insurance Company, you Must also complete and attach the Trading Partner Agreement to the ACS EDI Enrollment form.

• Trading Partner Agreement Form