- Check out what’s new!CEDI Enrollment
Enrolling with CEDI is easy!
Completing Forms
CEDI enrollment forms must be completed and submitted on-line. Once your information is entered into the form, click the “Submit” button at the bottom of the screen. This will generate a printable version of the form for you to print, sign, date, and fax to the number located on the printed form. Do not print the screen before you click on “Submit”.
We have provided check lists for new providers to help make the process easier.
CEDI Enrollment Check List for New Providers
Information about the Transaction Options for CEDI
Submitted CEDI enrollment forms will be issued Request Identification (RID) numbers which will appear on the printed copy of the form. The RID is used to track the submitted form. Forms that are printed before clicking the “Submit” button or have missing/invalid information will not be assigned an RID number. Verify your form(s) has an RID number before faxing.
IMPORTANT: Forms that are not printed after clicking on “Submit” and/or are not signed, dated, and faxed to CEDI will not be processed.
To help you avoid getting your forms returned, check out our guide on How to Avoid Common Errors When Completing Enrollment Forms
Checking the Crosswalk
CEDI recommends verifying your NPI and PTAN are linked on the crosswalk before completing enrollment forms. A crosswalk is the link established between the NPI and DME PTAN (Supplier ID). Verify your link using the tool below.
Checking Status of Submitted CEDI Forms
The On-line CEDI Enrollment Application Status Tool allows you to check the status of your CEDI enrollment form(s) instantly through an internet web portal. You will need the Request Identification (RID) number or the NPI, PTAN, and date of the on-line submission to obtain status information.
- Enrollment Application Status Tool Webinar Recording
(6 MB)
This Webinar will provide a walkthrough showing how to use the Enrollment Status Tool to check status of CEDI enrollment forms.- Transcript for Enrollment Status Tool Webinar Recording
You can also use the CEDI Interactive Voice Response (IVR) System to check the status of submitted enrollment forms 24 hours after the on-line submission
The CEDI Enrollment IVR Guide
To check status of your form(s) call 866-311-9184 Option 2 and follow the prompts. The system will request the RID number from the form in order to check status.
Enrollment Forms and Instructional Guides
Below are the enrollment forms used by CEDI. Review the “Why Complete This Form:” and “Additional Form Required” columns for at-a-glance information. Review the Instructional Guide if additional assistance is needed to complete the required form.
For important information about completing enrollment forms Click Here
Form Number |
Enrollment Forms and Instructional Guides |
Why Complete This Form: |
ADDITIONAL FORM REQUIRED |
|---|---|---|---|
| 1 |  - Instructional Guide |
Complete if:
|
Another Form is Required: Supplier Authorization Form OR Submitter Action Request Form |
| 2 |  - Instructional Guide |
Complete if:
|
Another Form may be Required: Enrollment Agreement Form |
| 3 |  - Instructional Guide |
Complete if:
|
Another Form may be Required: Enrollment Agreement Form |
| 4 | Address and Contact Information Change Form NOTE: This form cannot be used to transfer owners of a Trading Partner ID. If ownership changes, the new owner must request a new Trading Partner ID. |
Complete if:
|
If you need to update authorized contacts, please complete the Recertification form. |
| 5 |  - Instructional Guide |
Complete if:
|
If you only need to update the address, phone number, or fax number, complete the Address and Contact Information Change Form. |
Cancel and Removal Requests
Canceling Enrollment Form Requests: If you have submitted enrollment forms and would like to cancel the request, please send an e-mail to the CEDI Enrollment Department at cedienrollment@wellpoint.com with the Request ID (RID) number, the name of the form, date of the online submission, and contact information.
Deactivation of a Trading Partner ID: If you own a Trading Partner ID and will no longer be using it, please notify CEDI Enrollment by submitting your request on company letterhead. Please include the Trading Partner ID and associated PTAN and NPIs linked to your Trading Partner (Submitter) ID. The request on letterhead must be signed by the authorized person for that Trading Partner ID. Please fax to CEDI Enrollment at 315-442-4299 for processing.
What to Expect
When CEDI forms are submitted, an acknowledgment e-mail will be generated and sent back to the e-mail address on the form. (NOTE: The confirmation e-mail for the Supplier Authorization Form will be sent to the 3rd party biller or clearinghouse listed on the form.)
Once the request has been approved and processed, a setup confirmation will be sent via e-mail. For security purposes, confirmation of enrollment requests for a new Trading Partner (Submitter) ID will only receive the a confirmation e-mail with the Trading Partner ID. The Trading Partner (Submitter) will need to contact the CEDI Help Desk at 866-311-9184 to request the initial password prior to logging in. If an e-mail is returned as undeliverable, CEDI will respond with the setup confirmation via fax or mail.
Passwords
The initial password is a default password which will expire immediately and requires the user to establish a confidential, unique password. Passwords will expire every 60 days. Password requirements are listed below:
- Passwords must be eight (8) characters in length; no more and no less.
- Passwords must contain a combination of numbers and alpha characters.
- Passwords must include at least 1 uppercase and 1 lowercase letter; case sensitive.
- Passwords must contain a special character; for example @, #, $
- Passwords must be different than the last nine (9) passwords.
- After three (3) incorrect login attempts, the account will be locked. Please contact the CEDI Help Desk at 866-311-9184 to have your password reset.
- Passwords must not be stored in scripts, files, or applications unless compensating controls are in place
Note: Trading Partner (Submitter) IDs will automatically be suspended after 90 days of inactivity and become inactive after 13 months of inactivity.
CMS’ information security policy strictly prohibits the sharing or loaning of Medicare assigned IDs and passwords. Users should take appropriate measures to prevent unauthorized disclosure or modification of assigned IDs and passwords. Violation of this policy will result in revocation of all methods of system access, including but not limited to EDI front-end access or EDC RACF user access.