Enrollment

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

Important Enrollment Information (PLEASE READ):

• If you are an individual provider or pharmacy sending or receiving transactions from the Montana Department of Public Health and Human Services, you should download the provider enrollment packet.
   
• If you are a new electronic submitter in the State of Montana, an Electronic Billing Agreement (EBA) form may be required before submitting electronic transactions.
   
• Current providers with an Electronic Billing Agreement on file are not required to submit new forms.
   
• Provider EDI Authorization Form for Billing Agents /Clearinghouses: ACS EDI Gateway will no longer 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.  This form is included in the EDI Gateway Enrollment Packet.
   
• 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.

• EDI Submitter Enrollment Form Instructions
• EDI Submitter Enrollment Form
• EDI Trading Partner Agreement (PDF)
• EDI Trading Partner/Business Associate 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)
• EDI Trading Partner/Business Associate Agreement (PDF)

Electronic Billing Agreement (EBA)
If you are a new electronic submitter in the State of Montana, an Electronic Billing Agreement (EBA) form may be required before submitting electronic transactions.

Use the following electronic additional provider spreadsheet if you are submitting on behalf of more than 25 providers. Please call the ACS EDI Gateway Support Unit at 1.800.987.6719 for instructions on how to submit this spreadsheet with your enrollment forms.

• Additional Provider Spreadsheet

Please contact the ACS Provider Relations Unit for more information regarding the Electronic Billing Agreement and Power of Attorney Forms at .800.624.3958 (In-state) or                406.442.1837 (Helena or Out-of-state).

If you have any questions regarding the ACS EDI Gateway Enrollment Packet, please call our EDI Gateway Support Unit, Monday-Friday at 800.987.6719 - 8 a.m.-5 p.m. MST.