Electronic Commerce, as it applies to the healthcare industry, is the exchange of electronic media information between payers, providers and financial institutions. This exchange is accomplished through the use of electronic transactions developed by the American National Standards Institute under legislation, passed in 1996, known as HIPAA.

Empire’s EDI group is comprised of professionals who are trained to support our provider community in all aspects of Electronic Commerce. Communication is essential to the performance of Electronic Commerce; being the vehicle that transports all electronic transactions.

If your facility or practice is going to be submitting electronic claims to Empire for the first time, we will need some information from you before you can start. You will find everything you need right here, so let’s begin.

Electronic Commerce Forms

Following is a list of Electronic Commerce forms with a short description of their application for Institutional and Professional providers. If any apply to you just click on the form name on top of the description to display the form. Instructions for filling out the form and for its submission are included on the form. Click on the printer icon at the top of your browser to print the form then click on your browser’s Back button to return to this page.

Don’t forget to submit the necessary forms to the Communications Vendor once you have made your selection.

Institutional

EDI Enrollment
If you have never submitted claims electronically to Empire you first have to submit an EDI Enrollment form. This form is a contract between your facility and CMS.

Empire e-Link User Guide
Empire e-Link, is a web-based application used for sending and retrieving claims and related
electronic transactions. It uses features built into your web browser.

Submitter Action Request Form
This form is used to request a Submitter Id. You will need this Id. to send or receive electronic transactions. (This form is submitted online)

Medicare Part A Provider Logon Request Form
Request Logon Ids. for employees so they can access FISS, our interactive Medicare billing system. This will allow you to enter claims or correct claims that were submitted in batch mode. You can also see claim status and beneficiary eligibility.

Electronic Remittance Request
Sign up to receive your Remittance Advice electronically. You can also download PC-ACE or PC-Print, for free to translate and print or display your remittance. PC-ACE will also export an ASCII file that can be used for automatic posting. (This form is submitted online)

PC-ACE Pro32
You can download PC-ACE Pro32 to bill Medicare claims electronically, process your remittance or to check your claims for errors before you submit them.
Visit our PC-ACE Pro32 Support Center to learn more and to download the free software.

PC-Print
If you already have an electronic billing system and just want to use PC-Print to process your electronic remittance click here to download the free software.

PC-ACE/PC-Print Software Order
To order PC-ACE and PC-Print software on a CD click here.

Electronic Funds Transfer
Sign up for Direct Deposit of you Medicare payments. Print form CMS-588 from CMS’ website.

TCP/IP User Guide - for Medical and Institutional providers.

Page Last Modified: 12/18/07

Professional

EDI Enrollment
Submit this form if you are a new individual provider, a group practice or a new provider joining an enrolled group practice. This form is a contract between you and CMS.

Submitter Action Request Form
This form is used by batch submitters to request a Submitter Id. or to change vendors.

PC-ACE Pro32 Request Form
Request our free billing software, PC-ACE Pro32. With PC-ACE you will be able to manually enter or import your claims to create HIPAA compliant claim files for Medicare Part-B, Blue Shield and Commercial insurers.

Electronic Remittance Request
Sign up to receive your Remittance Advice electronically. Click here to download the free software Medicare Remit Easy Print (MREP) from CMS’ website to display and print your ERA.

Electronic Funds Transfer
Sign up for Direct Deposit of your Medicare Part B payments. Print Form CMS-588 from Empire’s website.

Request for QuickLink Contract
Bill commercial insurance companies through our QuickLink clearinghouse. We require one agreement for each provider. Please make sure your vendor’s software will support this.

Electronic Provider Agreement for Blue Shield
Each doctor that will be submitting Blue Shield claims to Empire must fill out and submit this form.

Technical Assistance

For technical assistance you can contact our
Enterprise EDI Solutions team, Monday through Friday
from 8:30AM to 4:30PM at 866-889-7322.

For Commercial EDI specific issues, please contact the Enterprise EDI Solutions team at 1-866-889-7322.
For NGS Medicare EDI specific issues, please contact the NGS EDI Help Desk at 1-877-273-4334.