|
To receive a Trading Partner ID and logon information, please complete and return the ACS EDI Gateway Enrollment Packet for Mississippi
Medicaid.Important Enrollment Information (PLEASE READ):
- ACS EDI Gateway, Inc. has a Trading Partner Agreement (TPA). This agreement must be executed between the provider/submitter and ACS EDI Gateway, Inc. as the covered entity.
- Execute the Trading Partner Agreement (TPA) if you are a provider/submitter sending and/or receiving standard format.
- Note
: ACS EDI Gateway prefers that providers/submitters execute this agreement online. However, if they are unable to access the agreement online and would prefer a paper copy, the agreement can
be downloaded from our GCRO web site or requested from our EDI Support Unit. [This agreement is included on the enrollment form.]
EDI Submitter Enrollment Packet for X12N Transactions
: This packet consists of the following documents:
- EDI Submitter Enrollment Form Instructions
- EDI Submitter Enrollment Form
- EDI Trading Partner Agreement (PDF)
EDI Provider Enrollment Packet for X12N Transactions:
This packet consists of the following documents:
- EDI Provider Enrollment Form Instructions
- EDI Provider Enrollment Form
- EDI Trading Partner Agreement (PDF)
Please mail or fax forms to:
ACS EDI Gateway, Inc.
ATTN: Provider Enrollment
P.O. Box 23078
Jackson, MS 39225
Fax: 601.206.3059 or 601.206.3015If you have any questions regarding the ACS EDI Gateway Enrollment Packet, please call our EDI
Gateway Support Unit, Monday-Friday at 866.225.2502 - 8 a.m.- 6p.m. EST. |
|
