Enrollment

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

Important Enrollment Information (PLEASE READ):

  • Data Service Center Agreement - (This packet includes the Electronic Data Interchange Agreements and EDI Information Sheets). The enclosed agreements are legally binding documents between the District of Columbia (MAA) and the provider. All providers must complete, sign, and return this packet to the address listed below before submitting production claims.

Mail Original Agreements to:
ACS EDI Gateway, Inc.
ATTN: Technical Support
P.O. Box 34734
Washington, D.C. 20043-4761
Fax: 202.906.8399

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

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

EDI WINASAP2003 Information Packet: The information packet consists of the following documents. To download these forms, please click on the document link below.

EDI Pharmacy Regisration Packet: The registration packet consists of the following documents. To download these forms, please click on the document link below.

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

Please mail or fax forms to:
ACS EDI Gateway, Inc.
ATTN: Technical Support
P.O. Box 34734
Washington, DC 20043-4761
Fax: 202.906.8399

If you have any questions regarding the Data Service Center Agreement, please call ACS Provider Enrollment Unit at 866.407.2005.

If you have any questions regarding the ACS EDI Gateway Enrollment Packet, please call our EDI Gateway Support Unit Monday - Friday at 866.407.2005 - 8 a.m.-5 p.m. EST.

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