Enrollment
 

To receive a Trading Partner ID and logon information, please complete and return the ACS EDI Gateway Enrollment Packet for Georgia Medicaid/PeachCare for Kids.

All electronic submitters are required to complete the Georgia Medicaid EDI Trading Partner Enrollment Form.

Important Enrollment Information (PLEASE READ):

• ACS EDI Gateway, Inc. has two types of agreements: 1) Trading Partner Agreement (TPA); 2) Trading Partner/Business Associate Agreement.  These agreements are executed between the provider/submitter and ACS EDI Gateway, Inc. as the covered entity.
  A provider/submitter should execute these agreements based on the following guidelines:
   
• Execute the Trading Partner Agreement (TPA) if you are a provider/submitter sending and/or receiving standard format.
   
• Execute the Trading Partner/Business Associate Agreement (TP/BAA) if you are a provider/submitter sending and/or receiving a non-standard format that must be converted to a standard format.
   
• Note:  ACS EDI Gateway prefers that submitters execute these agreements online.  However, if they are unable to access the agreements online and would prefer a paper copy, agreements can be downloaded from our GCRO web site or request them from our EDI Support Unit.

• Instruction Sheet for Submitter Enrollment Form
• Submitter Enrollment Form
• Instruction Sheet for Provider Enrollment Form
• Provider Enrollment Form
• Power of Attorney Form

Power of Attorney (POA) For Electronic Claims Submission: Providers who allow a billing agent to submit claims, or retrieve responses/reports, on their behalf MUST complete and return a signed original Power of Attorney form via mail to the address listed below.  Current providers with a Power of Attorney on file are not required to submit a new Power of Attorney form.

If you have any questions regarding the ACS EDI Gateway Enrollment Packet, please call our EDI Gateway Support Unit Monday - Friday at 800.987.6715 - 8 a.m.-5 p.m. EST.