EDI Enrollment Forms are often updated to ensure the most relevant data is collected and to make the enrollment process more efficient. Highmark Medicare Services has revised the separate Part A and Part B EDI Enrollment Forms and combined them into one set of forms, which can be used when enrolling either EDI Part A or Part B. However, you cannot enroll for both EDI Part A and Part B simultaneously on one form. If you wish to enroll for both EDI Part A and Part B, you must submit separate Enrollment Forms for your Part A and Part B enrollment. The new forms show a revised date of 01/08.

It is important that you use the most recent version of any EDI Enrollment Form when enrolling for EDI or updating your existing EDI status. Effective March 3, 2008, Medicare EDI Services will begin to return all EDI Enrollment Forms received that contain a form revision date older than 01/08. The form revision date is located in the lower left-hand corner of all EDI Enrollment Forms. Due to the form consolidation, some forms are being eliminated. The following chart shows the current form number with a crosswalk to the new form number.

Before completing and submitting an EDI Enrollment Form, please visit our website at:www.highmarkmedicareservices.com and download the most recent version of all EDI Enrollment Forms. This will ensure you are completing and submitting the most recent version of the EDI Enrollment Forms.