National Government Services

NGS Wisconsin Part A Workload (00450) EDC Migration

With the transition to the Enterprise Data Center, NGS is required to replace your current FISS/DDE User Ids with new IDs. To facilitate this task we are requiring that Patient Account Managers complete and submit the information contained in the online form below. Once the new User IDs are created, the NGS EDI Department will communicate these to you based on the Preferred Contact Method indicated in the form. Please note that all the information on the form is required. If you have any questions about the transition, please email us at AE_EDI@WELLPOINT.COM.

This transition affects only the following regions and this contact form should be completed for those providers: Medicare Part A for Wisconsin, RHHI for Wisconsin, Michigan, Minnesota, New York and New Jersey and Federally Qualified Health Centers for all regions.

We ask that you complete and submit this online form no later than March 14, 2008. Failure to receive this information by this date will jeopardize your facility's ability to access the FISS/DDE system when the transition is implemented on April 22, 2008.

Provider/Facility Name (required):

FISS User ID Contact Name (required):

Title (required):

Phone (required):

City (required):

State (required):

Fax:

Email (required):

Preferred Contact Method:

Medicare Legacy Provider Numbers:

To submit additional provider numbers check here

Please list all of your facility's current FISS IDs if you need to enter more then 20 FISS IDs an additional form will need to be completed:

ID	First Name:	Last Name:

System Availability (including IVR):

6:00AM -8:00 PM CST Monday - Friday

6:00AM-7:00 PM CST Saturday

Page Last Modified: 02/08/2008