|Trading Partner Enrollment Profile
|This page allows new trading partners to submit an enrollment application and profile online. It allows established trading partners to update their profile.
[Trading Partner] - [Trading Partner Enrollment/Profile]
|The Enrollment Wizard includes the following panels:
- Instructions: Presents general information about the enrollment process.
- Trading Partner Information: Allows the user to enter data needed to create the Trading Partner profile: the Trading Partner Name, Address, City, State, Contact Name and Phone Number, Authorized Representative Name and Phone Number. These are mandatory fields.
- Transaction Sets: Data must be exchanged in formats compliant with HIPAA X12N transaction rules. A Trading Partner can only submit and receive transactions in the formats defined in their Trading Partner Agreement.
The system supports exchange of data files with the following characteristics:
- X12 Compliant
- ASCII based
- Uncompressed (compressed data will be accepted with a future enhancement)
At least one transaction type must be selected to complete the Trading Partner Enrollment.
- Covered Providers: The user enters an AVRS/Web User ID for each of the Connecticut Medical Assistance Program providers for whom they are uploading and downloading transactions, with the effective date and end date of their association with the provider. If the End Date is unknown, the user enters 12/31/2299.
At least one provider must be added in order to complete Trading Partner Enrollment.
- Electronic Remittance Advice:
When the 5010 835 Transaction (Claim Payment/Advice) is selected in the Transaction Set, the Covered Provider panel does not display, and is replaced by the Electronic Remittance Advice panel. Each Provider record that is entered on this panel will be included in the Trading Partner's 835 Claim Payment/Advice.
The application data is screened online for required data elements and validation of associated provider identification. Invalid applications are not allowed to be submitted.
- Summary: Indicates that the trading partner profile is completed. The user clicks Submit to save and submit the Trading Partner Enrollment process.
After a successful submission, the Confirmation panel is displayed. It contains the Trading Partner ID and instructions for completing the account set-up and certification process. The user clicks the link for "TPP" to save and/or print the Trading Partner Enrollment Summary which contains the new Trading Partner profile.
All pages have an Exit and Clear button. Clicking Exit on any of panels brings up a warning message prior to exiting the panel. If the user clicks OK, the enrollment is cancelled and the user is redirected to the EDI page under the Trading Partner menu. The user clicks Clear to clear all data from the fields of the active panel.