Trading Partner Enrollment/Profile

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»	Instructions

This form is intended for clearinghouses, billing services, and software companies seeking to become trading partners. If you already have received a trading partner ID, and wish to update your TPP, then you must first log in to your secure portal account.
Personally identifiable information about providers is used for purposes directly related to health care program administration, such as determining the certification of providers or processing provider claims for reimbursement. Failure to supply the information requested may result in denial of payment for the services.
Trading partners are required to complete a trading partner profile containing specific transaction and contact information as the first step in the Electronic Data Interchange (EDI) enrollment process. The EDI Department must receive and process the profile request before trading partners may begin testing.
Please fax your profile request to: Gainwell Technologies EDI Assistance Center (877) 413-4421
**IMPORTANT** If your profile request is not received Gainwell Technologies will not be able to process your Trading Partner Profile.
Only one TPP needs to be completed for each trading partner, even if the trading partner represents multiple providers. Billing providers that possess multiple billing provider numbers, or billing services and clearinghouses that exchange the electronic transactions on behalf of trading partners need only return one profile form. Accurate and timely completion of the profile form will prevent delays in testing and approval for production processing.

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