Home
Forms Library
Electronic Data Interchange EDI Enrollment 8292 form

Electronic Data Interchange EDI Enrollment 8292 form-2025

Electronic Data Interchange EDI Enrollment 8292 form Preview on Page 1

Show details

4 out of 5

55 votes

The document outlines the Electronic Data Interchange (EDI) Enrollment process for providers submitting Medicare claims electronically. It includes sections for required information such as provider details, practice location, billing service information, and agreement terms. The document emphasizes compliance with Medicare regulations, responsibilities of the provider, and the technical requirements for electronic submissions. Additionally, it provides instructions for completing the enrollment form and contact information for assistance.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

The best way to edit Electronic Data Interchange EDI Enrollment 8292 form in PDF format online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Handling paperwork with our comprehensive and intuitive PDF editor is simple. Follow the instructions below to complete Electronic Data Interchange EDI Enrollment 8292 form online quickly and easily:

Log in to your account. Sign up with your credentials or create a free account to test the service prior to upgrading the subscription.
Upload a document. Drag and drop the file from your device or import it from other services, like Google Drive, OneDrive, Dropbox, or an external link.
Edit Electronic Data Interchange EDI Enrollment 8292 form. Easily add and highlight text, insert images, checkmarks, and symbols, drop new fillable areas, and rearrange or remove pages from your document.
Get the Electronic Data Interchange EDI Enrollment 8292 form accomplished. Download your modified document, export it to the cloud, print it from the editor, or share it with other people through a Shareable link or as an email attachment.

Benefit from DocHub, one of the most easy-to-use editors to quickly manage your documentation online!

See more Electronic Data Interchange EDI Enrollment 8292 form versions

We've got more versions of the Electronic Data Interchange EDI Enrollment 8292 form form. Select the right Electronic Data Interchange EDI Enrollment 8292 form version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (112 Votes)
2016	4 Satisfied (55 Votes)
2012	4 Satisfied (38 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is an EDI enrollment form?

Electronic Data Interchange (EDI) is an innovative digital communication tool that is used to deliver data from a provider to a payer. In order to be eligible to submit electronic claims to an insurance company, providers must complete EDI enrollment.

What is form 8292?

EDI Enrollment Form (8292) This form should be completed by providers using the SFTP connection and/or requesting access to the Fiscal Intermediary Shared System (FISS).

What is the phone number for Novitas EDI?

If your communication is very sensitive, or includes personal information, you may want to contact the EDI Department by phone: JL Customers: 1-877-235-8073, option 3. JH Customers: 1-855-252-8782, option 3.

What is EDI with Medicare?

EDI is the automated transfer of data in a specific format following specific data content rules between a health care provider and Medicare, or between Medicare and another health care plan.

What is the EDI format for electronic data interchange?

Standard EDI formats include X12, ANSI, EDIFACT and its subsets. The 868 EDI document provides a structure for EDI standards or portions of EDI standards in an electronic format. It provides users with the ability to send and receive standard data and use it to update application and translation software.