Mississippi Medical

Medicare of Mississippi      

  • Emdeon Link
  • Needs to be entered into GEMS
  • Vendor Submitter ID: C2YW Vendor Name: Apex EDI Site ID: 0001 Division ID: 17011
  • Payer ID – SMMS0

Medicare Enrollment Form

Direct

  • Direct Link- Cahaba
  • Direct Output- ZZ-Medicare MS
  • Both Emdeon’s and Direct Output must be entered in Claimstaker
  • The paperwork MUST be filled out electronically; the ONLY thing that can be handwritten is the Signature
  • Paperwork MUST be printed and faxed to Cahaba at (205) 402-9200
  • “Method of Interchange”,   and Professional Provider Telecommunications Network (PPTN) sections DO NOT need to be filled out
  • Page 4- system Access Request page DOES NOT need to be filled out, but must be signed at bottom

Medicare Enrollment Form

Medicaid of Mississippi    

  • Emdeon Link
  • Needs to be entered into GEMS
  • Vendor Submitter ID: C2YW Vendor Name: Apex EDI Site ID: 0001 Division ID: 17011
  • Payer ID – SKMS0

Medicaid Enrollment Form

BCBS of Mississippi      

  • Emdeon Link
  • Needs to be entered into GEMS
  • Vendor Submitter ID: C2YW Vendor Name: Apex EDI Site ID: 0001 Division ID: 17011
  • Payer ID – SB730

BCBS Enrollment Form

National Payers Requiring Enrollment

  • Railroad Medicare
  • DMERC (Region C)
  • ASHN

National Enrollment Forms