Electronic claim submission is a faster, more efficient method of claims submission that creates less paperwork, less claims preparation, and no postage or mailing costs!! If you are interested in being an electronic submitter, you may enroll via the online Trading Partner Agreement application by accessing the Trading Partner Enrollment/profile section of our website.

The Electronic Data Interchange (EDI) page contains the Provider Electronic Solutions (PES) downloads, Implementation Guides, Companion Guides, Vendor Interface Specifications, Trading Partner Agreement, Trading Partner Enrollment Instructions, information about Electronic Remittance Advice Specifications and EDI testing.

The Trading Partner Agreement (TPA) is a contractual agreement between parties who have chosen to become electronic business partners. The TPA stipulates the general terms and conditions under which the partners agree to exchange information electronically. The document defines participant roles, communication, HIPAA privacy and security requirements, and identifies the electronic documents to be exchanged. The TPA is used by all entities that wish to establish an electronic relationship with the Connecticut Medical Assistance Program. EDI production transactions will not be allowed until all testing has been successfully completed. Gainwell Technologies' EDI team will work with the trading partner's staff to exchange and analyze technical information. The TPA form for providers can be completed on line by accessing the Trading Partner Enrollment/profile section.

The Trading Partner Enrollment function allows new Trading Partners to submit their enrollment forms on-line. You may enroll by accessing the Trading Partner Enrollment/profile section of our website.

Trading Partner Enrollment Instructions

The Gainwell Technologies Provider Electronic Solutions software (PES) is available free of charge to any providers who wish to perform client eligibility verification, and to Long Term Care providers who wish to submit electronic transactions directly to the Connecticut Medical Assistance Program.

PES meets the current requirements of the Health Insurance Portability and Accountability Act (HIPAA) for the transmission of electronic transactions and transaction information. Listed below are links which explain how to create transactions for each claim type.

• Long Term Care
  • LTC Billing Examples
• Eligibility