Enrollment

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

Important Enrollment Information (PLEASE READ):

For questions regarding the ACS EDI Gateway Enrollment Packet, please call our EDI Gateway Support Unit, Monday-Friday at 888.333.5641.

• Provider Authorization Form - ACS EDI Gateway will not accept billing agent/clearinghouse client list.  We have supplied a Provider EDI Authorization Form that must be completed by the provider authorizing the Billing Agent or Clearinghouse to submit transactions and/or retrieve responses on their behalf.

• EDI Provider Enrollment Form
• PBM Pharmacy Enrollment Form
• PBM Trading Partner Agreement