CMS Pub. 100-04, ch. 24, § 30

Agreements)

(Rev. 13105; Issued- 04-10-25; Effective: 05-12-25; Implementation: 05-12-25)

Medicare FFS’ Trading Partner Agreement is comprised of two forms: 1) EDI

Registration and 2) EDI Enrollment. The forms are identified under CMS form 10164

and can be accessed at:

EDI Registration - https://www.cms.gov/files/document/cms-10164a.pdf and EDI

Enrollment - https://www.cms.gov/files/document/cms-10164b.pdf

CMS 10164A EDI Registration and 10164B EDI Enrollment forms have been

watermarked as ‘SAMPLE’ forms with the Office of Management & Budget (OMB)

approval of the 2024 EDI Paperwork Reduction Act (PRA) Package. The A/B MACs and

CEDI are currently using their own organization specific forms that are comparable in

terms of content to the CMS Sample forms 10164A and 10164B, to transmit data files

electronically between themselves and their trading partners.

The A/B MACs and CEDI Organization specific EDI Registration and EDI Enrollment

forms must include the OMB number at the bottom of the forms: OMB No. 0938-0983

approved by CMS.

The A/B MACs and CEDI Organization specific EDI Enrollment form must include the

following notice:

NOTICE: Federal law and applicable regulation and guidance, including IOM Pub. 100-

04, Chapter 24, Section 30.2, shall govern both the interpretation of this document and

the appropriate jurisdiction and venue for appealing any final decision made by CMS

under this document. This document shall become effective when signed by the provider.

The responsibilities and obligations contained in this document will remain in effect as

long as Medicare/Section 1011 claims or any other EDI transactions are submitted to

CMS or the CMS contractor. Either party may terminate this arrangement by giving the

other party thirty (30) days written notice of its intent to terminate, except as noted in

applicable regulation and guidance, including IOM Pub. 100-04, Chapter 24 , Section

30.2. In the event that the notice is mailed, the written notice of termination shall be

deemed to have been given upon the date of mailing, as established by the postmark or

other appropriate evidence of transmittal.

EDI registration and enrollment shall be instituted by the A/B MACs and CEDI and shall

accomplish the following:

1. Document the specific type of transactions and transmission methods to be utilized

and secure authorizations from the provider or other trading partner requesting to

exchange electronic administrative transactions, and

2. Designate the A/B MACs and CEDI with whom the provider or other trading partner

agrees to engage in EDI and implements standard policies and practices to ensure the

security and integrity of the information to be exchanged.

Under HIPAA, EDI applies to all covered entities transmitting the following

administrative transactions: ASC X12 837 institutional claim and ASC X12 837

professional claim, ASC X12 837 dental claim, ASC X12 835 remittance advice, ASC

X12 270/271 eligibility, ASC X12 276/277 claim status and NCPDP claim (and others

that are not used by Medicare at this time). Beginning on January 1, 2012, A/B MACs

and CEDI will also use the ASC X12 TA1 interchange acknowledgment, ASC X12 999

implementation acknowledgment and ASC X12 277CA claim acknowledgment error

handling transactions. In addition, CEDI and DME MACs will also use the NCPDP

standard transmission response transaction. Entities who prepare and submit the CMS

1500, CMS 1450 or CMS 10883 ADA Dental paper claim forms do not need to complete

an EDI registration.